Order Request
After you fill out this order request, we will contact you to go over details and availability before the order is completed. If you would like faster service and direct information on current stock and pricing please contact us at Contact us at 240-338-9989 or info@seniorssafespace.org. 

Once items are picked up you waive and Release all liability from Seniors Safe Space Corporation its constituents and property. Once received you assume all responsibilities for food, household, wound care, incontinence supplies, diapers, wipes, and all items requested. This for acknowledges covers the use, consumption, and or handling of all products, materials, food, and equipment provided by Seniors Safe Space Corporation regardless of how or where the items were obtained. 

This agreement shall be Governed by and construed in accordance with the laws of The State of Maryland. By completing this form you agree that you fully understand its terms and have given up substantial rights by completing this form and completion of form will release all liability to the fullest extent of the law.
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Are you a new or existing customer?
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What is the item you would like to order? *
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Your name *
Phone number *
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Questions and comments
Which of the following age groups is the order primarily for?
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