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Vera House Brochure & Poster Request Form
Please complete your request for materials below. TO HELP SAVE ON SHIPPING EXPENSES, we kindly ask that you coordinate pick up from our office whenever possible. Address: Vera House, Inc. 723 James St., Syracuse, NY 13206

Please refer to the Vera House website to view samples of each material: http://www.verahouse.org/about-us/our-brochures

PLEASE NOTE: Requests for materials outside Onondaga County (or the surrounding area) cannot be accommodated as our materials contain local (and state) resource information.
If you would like information on duplicating these materials in your area, please contact Colleen O'Brien at cobrien@verahouse.org or (315) 425-0818 x 2243.
Your name *
Your answer
I will pick up my materials on (allow 2 business days for processing):
MM
/
DD
/
YYYY
I am unable to arrange pick-up, please mail to the following address: (NOTE: large quantities cannot be mailed and must be picked up at our James St office).
Your answer
Business/Organization (if applicable)
Your answer
E-mail *
Your answer
Phone number *
Your answer
I would like materials in the following language(s) (if available): *
Brochures requested (select all that apply):
How many of each brochure would you like? *
Your answer
Posters requested:
How many posters would you like?
Your answer
Additional info?
Your answer
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