UPMC Employee T-shirt Order Form

* indicates a required field

To showcase UPMC's new brand and recognize our recent acknowledgement by U.S. News & World Report as one of the nation's best hospitals, we are offering every UPMC employee a free t-shirt. Please use this form to submit your order for your staff. Your department cost center will not be charged; we are collecting that information for verification and to avoid duplication.

Who are you, and how can we contact you? Corp Code (e.g. PAG00) *
Cost Center (five digits) *
First Name *
Last Name *
Department *
E-mail Address *

Where do we send the delivery? Mail Stop Code *
(e.g. MGE 01 03 02)

What's a mail code?

Unit/Room *
Floor *
Building *

How many of each t-shirt size do you need?

Each launch kit contains a t-shirt. Please fill out the number of each size you need below. The total quantity will automatically calculate to the total number of kits needed.

Small
Medium
Large
X-Large
XX-Large
XXX-Large
Total Quantity Needed