Hospital Employee Purchase Form

Visit one of the websites listed below and choose the item you are interested in purchasing through payroll deduction.
If you have a specific request for items not listed below, please email or call us for availability.
Due to issues beyond our control at the U.S. ports, some orders may take longer than expected.
Thank you for your patience.

DANSKO

DNKO1

Professional Black Box

$129.95

DNKO2

Professional Honey distressed

$139.95

DNKO4

Professional Cordovan Cabrio

$129.95

DNKO5

Professional Antique Brown

$129.95

DNKO6

xp 2.0 Black Floral Tooled

$149.95

DNKO7

Britney Red

$134.95

DNKO8

Britney Black

$134.95

DNKO10

Sam Black

$124.95

DNKO9

Sam Teak

$124.95

DNKO13

Pace Black Mesh

$139.95

DNKO11

Pace Grey Mesh

$139.95

DNKO12

Pace Navy Mesh

$139.95

DNKO14

LT Pro Black Leather

$129.95

DNKO15

LT Pro Paisley Sil/Blu

$139.95

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BIRKENSTOCK

BRK1

Arizona Black Birkoflor

$99.95

BRK2

Arizona Taupe Suede Soft Footbed

$135.00

BRK3

Arizona Oiled Habana Soft Footbed

$135.00

BRK4

Arizona Mocha Suede

$125.00

BRK5

Granada Oiled Tobacco Soft Footbed

$135.00

BRK6

Granada Black Birkoflor

$99.95

BRK7

Mayari Black Birkoflor

$99.95

BRK8

Mayari Oiled Habana

$125.00

BRK9

Mayari White Birkoflor

$99.95

BRK10

Gizeh Graceful Toffee Birkoflor

$99.95

BRK11

Gizeh White Birkoflor

$99.95

BRK12

Gizeh Habana oiled Leather

$125.00

ALEGRIA

ALG1

Debra Black Nappa

$129.95

ALG2

Debra Black Floral Embossed

$129.95

ALG3

Paloma Black Nappa

$129.95

ALG6

Debra Score Shoe

$129.95

ALG5

Kayla Black Nappa

$129.95

ALG7

Debra Aloha White

$129.95

KLOGS

KLG1

Naples Black Leather

$129.95

KLG2

Naples Black Tooled

$129.95

KLG3

Naples Brown Floral

$129.95

KLG4

Mission Black Leather

$129.95

KLG5

Mission Blue/Purple Leaf

$129.95

KLG6

Moxy Black Leather

$129.95

UGG

UG1

Classic Short Chestnut

$169.95

UG2

Classic Short Black

$169.95

UG3

Classic Mini Black

$149.95

UG4

Classic Mini Chestnut

$149.95

UG5

Ascot Black Leather

$129.95

UG6

Ascot China Tea Leather

$129.95

UG13

Classic Tall Chestnut

$199.95

UG14

Classic Tall Black

$199.95

UG15

Bailey Button Triplet Grey

$219.95

UG16

Bailey Button Triplet Black

$219.95

UG17

Bailey Button Black

$179.95

UG18

Bailey Button Chestnut

$179.95

UG7

Scuff Black Suede

$89.95

UG8

Scuff Chestnut Suede

$89.95

UG9

Coquette Black

$119.95

UG10

Coquette Chestnut

$119.95

UG11

Dakota Chestnut

$99.95

UG12

Dakota Espresso

$99.95

UG19

Fluff Yeah Ribbon Red

$99.95

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HOKA

HOK3

Bondi 7 in Black/White

$159.95

HOK1

Bondi 7 in Black/Black

$159.95

HOK4

Bondi 7 in BFOB

$159.95

HOK5

Clifton 7 in Black/Bronze

$159.95

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CROCS

CRK1

Classic Clog Black

$44.95

CRK2

Classic Clog Red

$44.95

CRK3

Bistro Clog Black

$59.95

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SALTWATER SANDALS

SLT7

Original Tan

$39.95

SLT8

Original White

$39.95

SLT9

Original Black

$39.95

SLT4

Surfer Pink

$39.95

SLT5

Surfer Tan

$39.95

SLT6

Surfer White

$39.95

Please fill out the form below and submit. If you have any questions or notes, please leave them within the last box.

Thanks – Roxanne’s Birkenstock