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Section 1 of 6
CRISIS ASSISTANCE APPLICATION (APPLICATIONS ARE NOT BEING ACCEPTED AT THIS TIME)


The Goods Bank NEO Crisis Assistance Program awards gift cards/shopping credit for products from our warehouse to our member organizations. Requests should be to assist a client/family who has experienced a catastrophic/crisis event. It is not intended to support everyday critical needs.  To become a member contact:  info@goodsbankneo.org or visit our website:  www.goodsbankneo.org 


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Is your organization a member of the Goods Bank?
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Section 2 of 6
ABOUT YOUR ORGANIZATION
Additional materials will be required before your organization can become a member. We will email them to you for completion.
Organization Name
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Year Established
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EIN#
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Mission Statement
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Name of organization leader (first, last, title)
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Leader's email
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Leader's phone
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County
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Contact for this application
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Email
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Section 3 of 6
Member Organization
Organization Name
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Program name if available
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Contact for this request (include full name)
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Title
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Email
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Phone
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Section 4 of 6
ABOUT YOUR CLIENT
FIRST NAME
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LAST NAME
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Tell us about the client in need
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What is the pressing need (at least 3 sentences)?:
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How would a GBNEO award help?
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Section 5 of 6
TERMS OF ACCEPTANCE
Generous donors make this gift possible. A thank you note or quote from you and/or the client would be very helpful. Feel free to use first name only.
Section 6 of 6
Terms
 • The Individual Assistance Award must be used within 30 days of receipt. Any funds not used will be forfeited.                                                                                      • A representative from your organization must accompany your client during their shopping visit.                            • Shopping must be completed within one visit. Any balance remaining at checkout will be returned to the GBNEO Member Assistance Program.                                                                                                                                  • All products must be picked up on the day of purchase.                                                                                                 • All products must be used or installed in your home only.                                                                                               ◦ No product may be sold, given away, or traded for money, goods, or services.                                                            • Clients must present a valid form of ID that matches the name supplied in your application to our staff at the warehouse.                                                                          

 Do you agree to these Terms and Conditions?
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Is your organization a member of the Goods Bank?
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ABOUT YOUR ORGANIZATION
Organization Name
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EIN#
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Mission Statement
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Leader's email
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Member Organization
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Program name if available
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Contact for this request (include full name)
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Title
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ABOUT YOUR CLIENT
FIRST NAME
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LAST NAME
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Tell us about the client in need
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What is the pressing need (at least 3 sentences)?:
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How would a GBNEO award help?
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TERMS OF ACCEPTANCE
Terms
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