Community Warehouse Delivery Request
Please use this form to request delivery from the CW Delivery Team. We will make every effort to honor date and time requests, but they are not guaranteed. You will be contacted via email by CW within 24 hours with appointment and delivery options.

Please note that the appointment location (Portland or Tualatin) *may* be assigned based on the ZIP code for delivery. ZIP code is required to request delivery.

After you have been contacted by CW with available appointment times, you have 24 hours to confirm or the appointment times will be released.

Case manager name *
Your answer
Case manager agency *
Your answer
Case manager email *
Your answer
Case manager phone *
Your answer
Preferred appointment location. Please note that appointment location *may* be assigned based on ZIP code for delivery. *
What is the delivery ZIP code? This is required. *
Your answer
Please provide full address, if known.
Your answer
Preferred appointment days/times:
Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon
Does the location have stairs, and if so how many flights? *
Your answer
Anything you would like our delivery team to know?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Community Warehouse. Report Abuse - Terms of Service