AmeriForm - Manufacturer and Supplier

ORDER SUMARY

Requisition Number:	U21-1191
Placed:	10-08-2021
Order Status:	Delivered
Total for Addons:	$8.00
Total Order:	$429.30
Paid Alowance Balance:	$429.30
Pick up at Store?	No

EMPLOYEE INFORMATION

Employee #:	176
Name:	JESSE
Last name:	QUINTERO JR.
Department:	Bus Operators
Allowance Balance:	$0.00

SHIPPING INFORMATION

Shipping date:
Delivery Date:
Shipping method:

CHANGE REQUISITION

New Number:

Order # 00079



Received	In Process	Shipped	Delivered

Shipping Address: Change

JESSE QUINTERO JR.

142 McNeel Rd

San Antonio, TX 78228

United States

Phone: 2102550444

Product List:

ANSI 3 Reversible Police Raincoat w/hood

Brand: Liberty

Size: Large

Quantity: 1

Color: HI VIS/BLACK

$66.70

Rothco Athletic Crew Socks

Brand: Rothco

Size: 10 - 13

Quantity: 1

Color: White

$3.91

Rothco Athletic Crew Socks

Brand: Rothco

Size: 10 - 13

Quantity: 1

Color: Black

$3.91

Rothco Touch Screen Neoprene Duty Gloves

Brand: Rothco

Size: Large

Quantity: 1

Color: Black

$19.59

Rothco 8 Point Police / Security Cap

Brand: Rothco

Size: 7 1/4

Quantity: 1

Color: Navy

$41.16

AUGUSTA MOISTURE WICKING SHIRT

Brand: Augusta SportsWear

Size: Large

Quantity: 3

Color: Navy

$11.82

Rothco Multi-Chamber MOLLE Assault Pack

Brand: Rothco

Size: One Size

Quantity: 1

Color: Black

$68.17

Mens New Generation® Stretch 4-Pocket Trouser

Brand: Horace Small

Waist: 38

Lenght: 28

Quantity: 2

Color: Navy

$66.15

CornerStone® - Select Snag-Proof Tactical Polo

Brand: CornerStone

Size: Large

Quantity: 2

Color: Royal

Flag Addon: US Flag

Patch Addon: Union Patch

$25.05

ORDER SUMARY

EMPLOYEE INFORMATION

SHIPPING INFORMATION

CHANGE REQUISITION

Order # 00079

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