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Shirt Order Form

We’re Sorry – Online shirt orders have closed. Please watch Workplace for updates on future shirt opportunities!

 

First Name: Last Name:

Phone Number/Extension:

How many shirts on this order?

Short Sleeve or Long Sleeve?

You must choose either Short or Long Sleeves on the following line.

This order is for Short Sleeve

The prices for the Short Sleeve shirts are as follows;
SMALL- XLARGE $8.00
2X $9.00
3X- 5X $10.00

If you want Short Sleeve, choose the size below:

This order is for Long Sleeve

The prices for the Long Sleeve shirts are as follows;

SMALL- XLARGE $11.00

2X $12.00

3X- 5X $13.00

If you want Long Sleeve, choose the size below:

If you need more than one size/style, complete a new order for each size/style you need indicating the quantity needed for each size/style.

By clicking the submit button below, you agree that you have double checked and triple checked this form for accuracy, and agree that you understand that if you need more than one size or style of shirt, you can easily go back to Workplace and order shirts of your other desired sizes and/or styles.

Pikeville Medical Center