Eco Femme screening form
Eco Femme partners with NGOs and other organisations to provide cloth pads and deliver educational programmes that foster a healthy, responsible and dignified menstrual experience for women and girls throughout India.
Pads can be supplied in bulk in a number of different ways:
1. Freely to economically-disadvantaged adolescent girls via our pad for pad programme (sponsored by international customers)
2. Subsidised for NGOs and individuals to reach economically-disadvantaged women
3. Bulk rate discount for CSR  funding and for foundations
We are committed to making sure that price does not become an obstacle and that free gifting, subsidies or discounts are offered based on genuine need. In order to help us evaluate your eligibility, we request you to fill in this screening form, return it to us, and we  will be in touch shortly with a reply.

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1. Your name: *
2. Email address: *
3. Organisation name: *
4. Your position within the organisation: *
5. Organisation website: *
6. Organisation address: *
7. Your contact phone number: *
8. Is your organisation Non-Profit? (Yes/No): *
9. If Yes to the above question, please provide your organisation's status and registration number:
10. In a few words, explain how you came to hear of Eco Femme and why you are interested in acquiring Eco Femme pads:
11. How many pads would you initially be interested in having?
12. Have you or someone in your organisation already used Eco Femme cloth pads? We strongly recommend that the person introducing cloth pads to your organisation either tries it herself or conducts some trials in small groups. Please let us know if this is a possibility.
13. Who will be receiving the pads? Please describe/provide some demographic information the intended target group of pad users e.g.  urban, semi urban or rural, age ranges, types of livelihood they are engaged in etc.
14. What is your distribution strategy? How do you propose to reach out to the girls or women that you are working with? What, if any, is the current engagement of your organisation with this target group?
15. Please indicate  which of the options below would be of most interest to you in regard to funding and/or supply of pads to your target group:                                                                          
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