DOC-1877B State Issued Shoe Order Form (2) (2).docx

DEPARTMENT OF CORRECTIONS WISCONSIN

Division of Management Services

DOC-1877B (4/2024)

STATE-ISSUED SHOE ORDER FORM

NOTE: Once order is confirmed by BRI, order cannot be cancelled or altered. No items can be returned.

2. LOCATION: CHOOSE ONLY ONE

LOCATION FROM DROP DOWN

OR

VENDOR INFORMATION

ITEM

SHOE SIZE COMBINATION

COST

VENDOR / SHIPMENT INFORMATION

GRAND TOTAL $0.00

12. COMMENTS (ORDER SPECIALTY SIZES HERE):

13. SIGNATURE OF DOC STAFF RECEIVING SHIPMENT:

DATE:

SHOE ORDERING INSTRUCTIONS

NOTE: Once order is confirmed by BRI order cannot be cancelled or altered. No items can be returned.

REQUIRED DATA (ORANGE) SECTION: In order to process this form, all fields in this area must be completed.

1. Contact Name: Enter the name of the DOC staff member who would be able to answer any questions from the vendor, Black River Industries (BRI), and to whom the completed shoe shipment will be delivered.

2. Location: Select the Facility or Center that is placing the order, from the appropriate drop-down menu.

3. Phone Number: Enter phone number including area code and extension if appropriate, for contact person indicated above.

4. Email: Enter email information for contact person, listed above.

5. Date Order Submitted: Enter date that this form is sent to: DOCuniforms@blackriverindustries.org.

6. Purchase Order Number: Enter PO# assigned to this particular order.

7. Purchase Order Date: Enter date of PO indicated on this form.

NOTE: Once order is confirmed by BRI order cannot be cancelled or altered. No items can be returned.

ITEM SELECTION (GRAY OR UNSHADED) SECTION: Each line has a drop-down menu for size and width. Choose the Size combination, fill in the Quantity to order and Unit Cost. Vendor will send available shoe style.

12. Use the comment section to order specialty sizes.

VENDOR INFORMATION (BLUE) SECTION: To be completed by Black River Industries Staff Only

8. Enter name of BRI employee who prepared this shipment

9. Enter date that order was shipped.

10. Signature of Delivery person

11. Indicate whether the shipment for each item is complete (entire amount ordered is included in shipment) or partial (less than entire amount ordered is included in shipment).

12. Use Comments section at the bottom of page one, to indicate when any “back ordered” items will be delivered.

STAFF INFORMATION (WHITE) SECTION: To be completed by Receiving Staff

13. DOC receiving staff will sign and date form, after verifying received amounts.

14. File this form with your appropriate facility property office.

SIZES AVAILABLE:

NOTE: Hiker shoes will NOT be issued until we have depleted the inventory of Work Boots 6” and Leather oxfords. Eventually only the Hiker shoe will be available phasing out the Work Boots and Leather Oxford shoes.

Hiker Shoe Polishable Hiker Shoe Mesh Work Boot 6” Leather Oxford Shoe

Stock Sizes available:

Widths Med and Wide in following sizes:

Widths XW in following sizes:

All Sizes not listed in Stock Sizes are specialty sizes. Use comment section to order specialty sizes.

All specialty sizes quoted per order.

DISTRIBUTION: Original (DAI) – Business Office File: Page 1 of 4 image3.png image4.png image1.png image2.jpeg