Heaven Sent Nonprofit Organization Intake Form
Please fill out the intake form below to be considered for immediate financial assistance.
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Email *
First Name *
Last Name *
Phone Number *
Mailing Address (No P.O. Box) *
Preferred Method of Payment *
What are you in need of for immediate financial assistance? (Be as specific and detailed as possible.) *
What are you in need of for immediate financial assistance? (Be as specific and detailed as possible.) - CONTINUED. (IF NEEDED.)
Who may we send a verification form to? (A form will be sent to verify your need for immediate financial assistance.) Please provide their First Name, Last Name, Phone Number and Email Address. *
In case Heaven Sent Nonprofit Organization funds lack at the moment would you like to be added to our waitlist? (Once funds are available our waitlist recipients will be selected by first come, first served basis.) *
I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me for benefits. *
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