Butterfly Box Request Form *Only available in Ottawa, ON*

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Your name *

Your email address *

This box is for *

myself

someone else

If the box is not for yourself, what is the name of the person receiving the box?

If the box is not for yourself, is there any note you would like us add?

If you are requesting the box for someone else, would you like...

the box to be delivered directly to the person it is requested for

the box to be delivered to you so you can deliver it to the person yourself

Other:

Clear selection

What is the address the box is to be delivered to? *

Please tell us what area of town of the delivery *

East (Orleans, Limoges, Russell )

East (Gloucester)

Central

Merivale and area

South (Findlay Creek)

Riverside South

South West (Barrhaven)

West (Kanata, Stittsville)

West (Carleton Place, Almonte)

Other:

What type of dwelling is the box being delivered too? *

House (front door)

Apartment

Townhouse/Condo

Other:

If you chose apartment, please email butterflyboxottawa@gmail.com to arrange a time for delivery as we can not just leave it outside.

If you chose townhouse/condo, are there any special instructions? For example: front door set away from street or house is accessible by walking only

Tell us how you heard about the Butterfly Box? *

Submit

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