Safety Equipment Request
Cut Level 2 Gloves
Size: [select glove-size1 first_as_label “Select Size” “Small” “Medium” “Large” “X-Large”]	Size: [select glove-size2 first_as_label “Select Size” “Small” “Medium” “Large” “X-Large”]	Size: [select glove-size3 first_as_label “Select Size” “Small” “Medium” “Large” “X-Large”]	Size: [select glove-size4 first_as_label “Select Size” “Small” “Medium” “Large” “X-Large”]
Qty: [select glove-qty1 first_as_label “Select Qty” “2” “4” “6” “8” “10”]	Qty: [select glove-qty2 first_as_label “Select Qty” “2” “4” “6” “8” “10”]	Qty: [select glove-qty3 first_as_label “Select Qty” “2” “4” “6” “8” “10”]	Qty: [select glove-qty4 first_as_label “Select Qty” “2” “4” “6” “8” “10”]
Safety Glasses
Qty: [select glasses-qty first_as_label “Select Qty” “2” “4” “6” “8” “10”]

[submit “Submit Request”]