Agency Name

Agency Mailing Address

City

State

Zip Code

Is the agency's mailing address the same as its shipping address?

YesNo

Shipping Information

Shipping Address

Shipping City

Shipping State

Shipping Zip Code

Please provide the following information for the best point-of-contact within the agency:

First Name

Last Name

Relationship to Agency

Email Address

Phone Number

Preferred method of communication:

It is very important that CWS receives contact information for someone who is on-site at the agency when kits/blankets are delivered so that we can coordinate drop-offs and time-sensitive shipment details. Have you already provided contact information for a responsible party to accept the shipment?

YesNo

First Name

Last Name

Relationship to Agency

Email Address

Phone Number

Preferred method of communication:

If the requesting agency does not have 501(c)(3) status, it is necessary to have another IRS tax exempt agency assume responsibility for the materials. Please fill out the information below for the 501(c)(3) agency assuming responsibility.

Name of 501(c)(3) agency assuming responsibility

Please attach a copy of the 501(c)(3) IRS Determination Letter forms for the affiliated agency assuming responsibility of materials.

Mailing Address

City

State

Zip

Contact's First Name

Contact's Last Name

Contact's Phone Number

Contact's Email Address

# of Lightweight Fleece Blankets (suggested increments of 30)

# of Heavyweight Wool Blankets (suggested increments of 25)

# of Hygiene Kits (suggested increments of 60)

# of School Kits (suggested increments of 30)

# of Emergency Cleanup Buckets (suggested increments of 36)

# of Welcome Backpack Kits (limited inventory)

# of Period Packs (suggested increments of 35)

Kits/Blankets are free of charge thanks to the generosity of donors and organizations. If, however, you would like to make a donation to help support this program, you can do so through our CWS Kits donation page or our CWS Blankets donation page. Thank you!