ADDIE'S ATTIC EMERGENCY CLOTHING ORDER FORM
please fill out ONE FORM FOR EACH PERSON. MAKE SURE TO INCLUDE THE PRIMARY HOUSEHOLD NAME ON EACH FORM IF THERE ARE MULTIPLE PEOPLE IN THE FAMILY
* Required
LAST NAME OF HEAD OF HOUSEHOLD
*
Your answer
FIRST and LAST NAME of CUSTOMER
*
Your answer
PLEASE DESCRIBE THE EMERGENCY
*
House/Apartment Fire
Emergency Relocation (this could be a DV situation or unexpected move)
Homelessness
Recently Released from Incarceration/Jail
Transitional Housing
Required
CONTACT (Phone/Text/Email). WE WILL CONTACT YOU WHEN YOUR ORDER IS READY. THIS MAY TAKE A FEW DAYS.
*
Your answer
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