Uniform Request
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SOMERSET-PULASKI COUNTY EMS
UNIFORM REQUEST
Employee Name *
Rank/Status *
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MAJOR
CAPTAIN
LIEUTENANT
FULLTIME PARAMEDIC
FULLTIME AEMT
FULLTIME EMT
PARTTIME PARAMEDIC
PARTTIME AEMT
PARTTIME EMT
Date
Items
Description
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5.11 POLO
PROPPER ICE POLO
PROPPER UNIFORM POLO
PROPPER SUMMER POLO
CORNER STONE POLO
PROPPER CLASS B – LONG SLEEVE
PROPPER CLASS B – SHORT SLEEVE
5.11 CLASS B – SHORT SLEEVE
5.11 CLASS B – LONG SLEEVE
5.11 DUTY SHIRT
PROPPER DUTY SHIRT
BLAUER DUTY SHIRT
TEE SHIRT – SHORT SLEEVE
TEE SHIRT – LONG SLEEVE
5.11 EMS PANTS
5.11 TAC LITE PANTS
5.11 STRYKE PANTS
PROPPER EMS PANTS
PROPPER KENTICS
TACTICAL RESEARCH BOOTS
BATES BOOTS
5.11 BOOTS
BLAUER BOOTS
ROCKY BOOTS
BELT
EMS TOBOGGAN
EMS HAT
5.11 JACKET
LIBERTY JACKET
OTHER
Qty
Style
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Men
Women
Shirt Size
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N/A
X-SMALL
SMALL
MEDIUM
LARGE
XL
2XL
3XL
4XL
5XL
Pant/Boot Size
Price
Amount
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Total
Other
Notes
Person(s) To Be Notified (use A Comma To Separate Email Addresses; Do Not Add a Space After the Comma)
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Date Ordered:
P.O. #
Date Obtained
Obtained By
