Hospital Employee Purchase Form

IMPORTANT UPDATE – PLEASE READ

Due to complications with shipping, orders for Birkenstock and Crocs are limited to what we have on hand or pending orders.
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

DNKO16

Professional Fragment Patent

$149.95

DNKO13

Pace Black Mesh

$139.95

DNKO11

Pace Grey Mesh

$139.95

DNKO12

Pace Navy Mesh

$139.95

DNKO14

LT Pro Black Leather

$139.95

DNKO17

LT Pro Love Patent

$139.95

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ALEGRIA

ALG1

Debra Black Nappa

$129.95

ALG2

Debra Black Floral Embossed

$129.95

ALG3

Paloma Black Nappa

$129.95

ALG9

Paloma I Love you Mucha

$129.95

ALG5

Kayla Black Nappa

$129.95

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KLOGS

KLG1

Naples Black Leather

$139.95

KLG2

Naples Black Tooled

$139.95

KLG7

Moxy Candy Skulls Patent

$139.95

KLG6

Moxy Black Leather

$139.95

KLG8

Hadley Black/White

$119.95

KLG4

Mission Black Leather

$139.95

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

UG20

Fluff Yeah Black

$99.95

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HOKA

HOK8

Women’s Bondi SR in Black

$169.95

HOK9

Women’s Bondi SR in White

$169.95

HOK10

Men’s Bondi SR in Black

$169.95

HOK6

Clifton 8 in Aquarelle/Eggshell

$139.95

HOK7

Clifton 8 in Outerspace/Vallarta Blue

$139.95

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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

$42.95

SLT8

Original White

$42.95

SLT9

Original Black

$42.95

SLT4

Surfer Pink

$42.95

SLT5

Surfer Tan

$42.95

SLT6

Surfer White

$42.95

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