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Custom Apparel & Websites
Hospital Name
Department
Name (First and Last)
Title
Email Address
Phone Number (Cell if we can text)
Best Method to Contact
Phone
Email
Text
Ordering Method
Custom Website – No Markup
Custom Website – Markup for Fundraiser
Custom Website - Open 24/7 (need to qualify)
Bulk Order
I’m not sure, can we discuss these options.
Interested in: (select all that may apply)
T-Shirts
Polo Shirts
Sweatshirts
Outerwear – Pullovers
Outerwear – Jackets
Blazers
Scrubs
Other (Please Specify)
Approximate Qty Needed
50 to 100
100 to 200
200 to 500
500 or more
I don’t have a clue.
Delivery Date Requested
Urgent Request
Yes
No
Additional Comments
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