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.
It may take several days to fill your orders. WE WILL CALL YOU WHEN YOUR ORDER IS READY.
IF YOU ALSO PLACED A HYGIENE ORDER and you know it is ready BUT you would like to pick up your hygiene and clothing orders at the same time, wait until we call you about your CLOTHING order before coming by.
You can have SOMEONE ELSE pick up your orders for you. There is a spot on this form where you can write their name.
ONCE YOU ARE CALLED, YOUR ORDER WILL BE HELD FOR ONE WEEK. IF IT IS NOT PICKED UP BY THAT ONE-WEEK DEADLINE, IT WILL BE UNPACKED.
* Required
TODAY'S DATE
*
MM
/
DD
/
YYYY
LAST NAME OF HEAD OF HOUSEHOLD
*
Your answer
FIRST and LAST NAME of CUSTOMER (Remember, one form for each person in your household!)
*
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
IF SOMEONE ELSE WILL BE PICKING UP YOUR ORDER FOR YOU, PLEASE WRITE THEIR NAME IN THE SPACE BELOW.
Your answer
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