AmeriForm - Manufacturer and Supplier

ORDER SUMARY

Requisition Number:	U22-1784
Placed:	03-19-2022
Order Status:	Delivered
Total for Addons:	$24.00
Total Order:	$379.76
Paid Alowance Balance:	$379.76
Pick up at Store?	No

EMPLOYEE INFORMATION

Employee #:	9797
Name:	DANIEL H.
Last name:	CASAREZ
Department:	Maintenance
Allowance Balance:	$0.00

SHIPPING INFORMATION

Shipping date:
Delivery Date:
Shipping method:

CHANGE REQUISITION

New Number:

Order # 01365



Received	In Process	Shipped	Delivered

Shipping Address:

DANIEL H. CASAREZ

1431 San Casimiro

San Antonio, TX 78214

United States

Phone: 2104277712

Product List:

Rothco Athletic Crew Socks

Brand: Rothco

Size: 9 - 11

Quantity: 4

Color: Black

$3.91

MENS INDUSTRIAL S/S WORK SHIRT

Brand: Red Kap

Size: Medium

Quantity: 2

Color: Navy

Flag Addon: US Flag

Patch Addon: Union Patch

$13.54

Hi-Visibility Soft Shell Jacket - Class 3

Brand: Red Kap

Size: Medium

Quantity: 1

Color: Yellow and Black

$83.35

MENS INDUSTRIAL 65/35 L/S WORK SHIRT

Brand: Red Kap

Size: Medium

Quantity: 4

Color: Navy

Flag Addon: US Flag

Patch Addon: Union Patch

$15.74

ANSI 3 Reversible Police Raincoat w/hood

Brand: Liberty

Size: Medium

Quantity: 1

Color: HI VIS/BLACK

$69.70

Mens DuraKap® Industrial Pant

Brand: Red Kap

Waist: 34

Lenght: 29

Quantity: 4

Color: Navy

$16.65

JERZEES FULL ZIP HOODED SWEATSHIRT

Brand: Jerzees

Size: Medium

Quantity: 1

Color: Navy

$30.43

ORDER SUMARY

EMPLOYEE INFORMATION

SHIPPING INFORMATION

CHANGE REQUISITION

Order # 01365

store information

Company Information

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