Duke Clerical Uniform Program 2019 Order Form

Employee Name (Print) Date Employee ID# Employee Signature

Authorized Signature Practice Name

( ) Phone number Shipping Street address

Account: 50274 ______Last 5 Digits of the Practice Main Phone # (Practice #) City, State, Zip Clerical - Women's Shirts Qty by Size - Enter qty needed in white box below size Style Description XSM SML MED LGE XLG XXL 3XL 4XL Range Price Total Qty Ext. Price IDBG4703-LB Women's Light Blue 3/4 Sleeve V-Neck Tee. 1x1 XSM-XLG $ 21.40 Rib Knit. Hemmed Sleeves and Bottom. 6.5 oz. 95% Cotton/5% Spandex. Logo Options: Duke Primary Care 006, Tape#: 072814-037, Duke XXL $ 22.40 Urgent Care 002, Tape#: 102414-064. Modern Fit 3XL $ 24.40

4XL $ 25.40 IDBG6218-LB Women's Light Blue 3/4 Stretch Blouse. Turned XSM-XLG $ 32.80 Up Cuffs. Wrinkle Resistant with Stain Release. Curved Side Panels. Matching Pearlized Buttons. 58% Cotton/39% Poly/3% Spandex. Logo XXL $ 33.80 Options: Duke Primary Care 006, Tape#: 072814- 037, Duke Urgent Care 002, Tape#: 102414-064. 3XL $ 35.80 Classic Fit. 4XL $ 36.80 IDBG6218-RO Women's Royal 3/4 Stretch Blouse. Turned Up XSM-XLG $ 32.80 Cuffs. Wrinkle Resistant with Stain Release. Curved Side Panels. Matching Pearlized Buttons. 58% Cotton/39% Poly/3% Spandex. Logo XXL $ 33.80 Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent Care 002, Tape#: 3XL $ 35.80 102414-064. Classic Fit. 4XL $ 36.80 IDLB708-NV Women's Navy Scoop Neck Blouse. Pleated Cap XSM-XLG $ 40.10 Sleeve. Bust Darts. 5.1 oz. 95% Poly/5% Spandex. Logo Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent Care XXL $ 41.60 002, Tape#: 102414-064. Modern Fit. 3XL $ 43.10

4XL $ 44.60 IDLB756-RO Women's Royal Long Sleeve Woven Pullover XSM-XLG $ 43.85 Shirt. Two Button Y-Line Placket. Chest Pockets with Buttons. Back Yoke. Front and Back Darts. 70% Poly/27% Nylon/3% Spandex. Logo XXL $ 44.35 Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent Care 002, Tape#: 3XL $ 46.85 102414-064. Contemporary Fit. 4XL $ 48.35

Clerical - Women's Maternity Top Qty by Size - Enter qty needed in white box below size Style Description SML MED LGE XLG XXL 3XL 4XL Range Price Total Qty Ext. Price ID5029-FB Women's French Blue 3/4 Sleeve Stretch Maternity Blouse. Front and Back Darts. SML-XLG $ 36.15 Broadcloth. 66% Cotton/30% Polyester/4% Spandex. Logo Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent Care 002, Tape#: 102414-064. Maternity Fit.

Clerical - Women's Sweaters Qty by Size - Enter qty needed in white box below size Style Description XSM SML MED LGE XLG XXL 3XL 4XL Range Price Total Qty Ext. Price ID7026-NV Women's Navy Open Cardigan Sleeveless Sweater Vest. Lower Front Welt Pockets. Tubular XSM-XLG $ 39.70 Bottom Hem. 52% Cotton/31% Acrylic/17% Nylon. Logo Options: Duke Primary Care 006B, XXL $ 43.20 Tape#: 072914-040, Duke Urgent Care 002, Tape#: 102414-064. Classic Fit. 3XL-4XL $ 45.00

ID7056-NV Women's Navy Open Front Cardigan. Hemmed Cuff and Bottom. Flattering Silhouette. Longer XSM-XLG $ 42.35 Length. 52% Cotton/31% Acrylic/17% Nylon. Logo Options: Duke Primary Care 006B, Tape#: XXL $ 46.15 072914-040, Duke Urgent Care 002, Tape#: 102414-064. Classic Fit. 3XL-4XL $ 48.05

Pursuant to and incorporating the terms of the agreement between iD by Landau® and Duke Primary Care. 02.2019 Return Policy: Defective goods without logo may be returned within 30-days of purchase with an approved Return Merchandise Authorization Number. Page 1 Subtotal

Classic Fit: Designed for comfort. Generously cut for ease of movement. Modern Fit: Flattering shape. Contours the body without limiting movement. Contemporary Fit: Tailored silhouette. Designed to complement your shape. P.O. Box 516 Fax: 800-252-1832 Olive Branch, MS 38654 Email: [email protected] Duke Clerical Uniform Program 2019 Order Form

Employee Name (Print) Date Employee ID# Employee Signature

Authorized Signature Practice Name

( ) Phone number Shipping Street address

Account: 50274 ______Last 5 Digits of the Practice Main Phone # (Practice #) City, State, Zip

Clerical - Women's Skirt and Pants Qty by Size - Enter qty needed in white box below size Style Description Range Price Total Qty Ext. Price Women's Navy Microfiber Straight Skirt. Back iD9792-NV 0-20 $ 32.75 Button and Nylon Zipper, Back Kick Pleat, Lined. Length (0-18): 25", Length (20-28): 26". 100% 22-24 $ 37.05 Polyester Microfiber. Classic Fit. 26 $ 39.20

Style Description Qty by Size - Enter qty needed in white box below size Range Price Total Qty Ext. Price ID8279-NV Women's Navy Flat Front Pant. Button Closure, Regular Length 30" Inseam Nylon Zipper. Elastic Back. Moisture Wicking. Two Front Pockets. Soil and Wrinkle Resistant. 2-20 $ 38.30 6.2 oz. 100% Poly. Classic Fit. 22-24 $ 43.75 26 $ 45.65 Petite Length 28" Inseam Inseams Available: 28 ", 30", and 32" 0-20 $ 38.30 22-24 $ 43.75 26 $ 45.65 Tall Length 32" Inseam 6-20 $ 38.30 22-24 $ 43.75 26 $ 45.65 Style Description Qty by Size - Enter qty needed in white box below size Range Price Total Qty Ext. Price IDBG6001P-NV Women's Navy Twill Flat Front Pant. Teflon Stain Regular Length 30" Inseam Resistant. Angled Front Pockets. Two Back 0-18 $ 36.75 Pockets. Back Elastic. Button Closure. Nylon Zipper. 7.25 oz. 60% Cotton/40% Poly. Classic 20-26 $ 38.75 Fit. Petite Length 28" Inseam Inseams Available: 28 ", 30", and 32" 0-18 $ 36.75 20-26 $ 38.75 Tall Length 32" Inseam 0-18 $ 36.75 20-26 $ 38.75 Clerical - Men's Shirts Qty by Size - Enter qty needed in white box below size Style Description SML MED LGE XLG XXL 3XL 4XL 5XL 6XL Range Price Total Qty Ext. Price IDBG7218-LB Men's Light Blue Long Sleeve Stretch Poplin SML-XLG $ 32.80 Shirt. Spread Collar. Chest Pocket, Double Back Yoke. Stain Release and Wrinkle Resistant. Pearlized Buttons. 58% Cotton/39% Poly/3% XXL $ 33.80 Spandex. Logo Options: Duke Primary Care 006, Tape#: 072814-037, Duke Urgent Care 002, 3XL $ 35.80 Tape#: 102414-064. Classic Fit. 4XL $ 36.80

5XL $ 37.80

6XL $ 38.80 IDBG7218-RO Men's Light Blue Long Sleeve Stretch Poplin SML-XLG $ 32.80 Shirt. Spread Collar. Chest Pocket, Double Back Yoke. Stain Release and Wrinkle Resistant. Pearlized Buttons. 58% Cotton/39% Poly/3% XXL $ 33.80 Spandex. Logo Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent Care 3XL $ 35.80 002, Tape#: 102414-064. Classic Fit. 4XL $ 36.80

5XL $ 37.80

6XL $ 38.80

Employee Name (Print) Date Employee ID# Employee Signature

Authorized Signature Practice Name

( ) Phone number Shipping Street address

Account: 50274 ______Last 5 Digits of the Practice Main Phone # (Practice #) City, State, Zip

Clerical - Men's Shirts Qty by Size - Enter qty needed in white box below size Style Description SML MED LGE XLG XXL 3XL 4XL 5XL 6XL Range Price Total Qty Ext. Price IDBG7266S-LB Men's Light Blue Short Sleeve Superblend Poplin SML-XLG $ 27.10 Shirt. Button Down Collar. Double Back Yoke. Left Chest Pocket. Stain Release and Wrinkle Resistant. Two Side Back Pleats. Bone Buttons. XXL $ 28.10 5.5 oz. 65%Poly/35% Cotton. Logo Options: Duke Primary Care 006, Tape#: 072814-037, 3XL $ 30.10 Duke Urgent Care 002, Tape#: 102414-064. Classic Fit. 4XL $ 31.10

5XL $ 32.10

6XL $ 33.10 IDBG7266S-RO Men's Royal Short Sleeve Superblend Poplin SML-XLG $ 27.10 Shirt. Button Down Collar. Double Back Yoke. Left Chest Pocket. Stain Release and Wrinkle Resistant. Two Side Back Pleats. Bone Buttons. XXL $ 28.10 5.5 oz. 65%Poly/35% Cotton. Logo Options: Duke Primary Care 006B, Tape#: 072914-040, 3XL $ 30.10 Duke Urgent Care 002, Tape#: 102414-064. Classic Fit. 4XL $ 31.10

5XL $ 32.10

6XL $ 33.10

Clerical - Men's Sweater Qty by Size - Enter qty needed in white box below size Style Description SML MED LGE XLG XXL 3XL 4XL Range Price Total Qty Ext. Price ID4072-NV Men's Navy Quarter Zip Lightweight Pullover Sweater. Rib Knit Trim at Collar and Placket. SML-XLG $ 44.10 Nylon Zipper and Metal Pull. 52% Cotton/31% Acrylic/17% Nylon. Logo Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent XXL $ 48.10 Care 002, Tape#: 102414-064. Classic Fit. 3XL-4XL $ 50.10

ID4092-NV Men's Navy V-Neck Fine Gauge Sweater Vest. Rib Knit Neck Band, Cuff, and Waistband. 85% SML-XLG $ 27.75 Cotton/15% Nylon. Logo Options: Duke Primary Care 006B, Tape#: 072914-040, Duke Urgent Care 002, Tape#: 102414-064. Classic Fit. XXL $ 30.90

3XL-4XL $ 32.50

Clerical - Men's Pant Qty by Size - Enter qty needed in white box below size Style Description 30" Inseam Price Total Qty Ext. Price iD2578-NV Men's Navy Easy Fit Adjustable Waist, Flat Front 28/30-42/30 $ 29.25 Chino Pant. Two Front and Two Back Pockets. 44/30-48/30 $ 32.95 Moisture Wicking, Soil Release Finish and 50/30-54/30 $ 34.80 Wrinkle Resistant. (65% Polyester/35% Cotton) 32" Inseam Price Total Qty Ext. Price Classic Fit. 28/32-42/32 $ 29.25 44/32-48/32 $ 32.95 Inseams Available: 30", 32" and 34" 50/32-54/32 $ 34.80 34" Inseam Price Total Qty Ext. Price 28/34-42/34 $ 29.25 44/34-48/34 $ 32.95 50/34-54/34 $ 34.80 Pursuant to and incorporating the terms of the agreement between iD by Landau® and Duke Primary Care. 02.2019 Return Policy: Defective goods without logo may be returned within 30-days of purchase with an approved Return Merchandise Authorization Number. Page 3 Subtotal

Classic Fit: Designed for comfort. Generously cut for ease of movement. Page 2 Subtotal

Modern Fit: Flattering shape. Contours the body without limiting movement. Page 1 Subtotal

Contemporary Fit: Tailored silhouette. Designed to complement your shape. Freight

P.O. Box 516 Fax: 800-252-1832 Total Olive Branch, MS 38654 Email: [email protected]