Wayne Boot Truck Survey
Please fill out the below survey and select the options below that best describe the needs of your employees. Currently we are only available in and around Houston.
Company Name:
Contact Person:
Phone Number:
Email Address:
Company Safety Requirements (please mark all that apply):
Steel Toe
Alloy Toe
Composite Toe
Met Guard
Pull On
Lace Up
All Leather Only
Puncture Resistant
Static Dissipative
Slip Resistant
Oil Resistant
Waterproof
Defined Heel
Electrical Hazard
6" Minimum
Leave Blank
Number of Employees:
Number of Employees Required to
Wear Safety Shoes/Boots:
Please tell us any additional information that will help us better serve your company: