Scrub Jacket and Lab Coat

Please provide the following ordering information

First name: Last name: Email: Phone:

Street: City: State: Zip Code:
Discount coupon enter code: Discounts will be refunded back to your Credit Card or PayPal

Scrub Jacket $30.00ea. (Own fabric $20.00ea.)

Price: Select a Print: or Solid Color:

Options: Buttons: Neck Style: Cuff: Pockets:

Measurements: Chest/Bust: Waist: Bicep: Hip:

Arm Length: Jacket Length:

Appliques $2.00 Price: Appliques:

Please specify, where Appliques to be placed in the "Special Request" box

Lab Coat $40.00ea. Price: Solid Color:

Options: Pockets: Buttons: Cuff:

Measurements: Chest/Bust: Waist: Bicep: Hip:

Arm Length: Coat Length:

Appliques $2.00 Price: Appliques:

Please specify, where Appliques to be placed in the "Special Request" box

Price: Scope Coat $3.00 when purchased with Jacket
Scope Length: (Measure length below Y to the diaphragm)
Note: Scope coat will be made from same fabric that you choose for your jacket

Embriodery $5 for each first line, $3 for each second and third line. Additional 2 weeks for orders.

Price:

Line 1:
Line 2:
Line 3:

Thread Color:
Font Style:
Placement:

Special Request and/or questions:

Please complete the following questions, so we can improve our services.

How did you hear about us?     Other:
Are you a returning customer:
If so, use existing measurements:
Do you want to be notified of new fabrics or specials:
Join the Birthday Club & receive discount:     Birth Date: xx-xx-xx