1. Customer Information

* 1. Item is on Order

* 2. Department:

* 3. Customer Information:

* 4. Item(s) Requested:

* 5. If we do not already stock this product, would you like us to? (is this something you would purchase over and over)

* 6. Enter Employee Name and Store Location (Enter 29 or 32 only)

* 7. Have you already paid?

* 8. Price Quoted:

* 9. Other Comments:/Is item Being Transferred from Roanoke/Burlington?

* 10. Item is being transferred from Roanoke or Burlington?

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