PINCH Request Form
This form is for local providers (nonprofits, social service agencies, schools, etc.) to request basic needs items on behalf of their clients who cannot access services themselves.  

If you are an individual who needs assistance, please visit our Clothes Cabin Tues/Weds 9-3pm or Thurs 6-8pm (no appointment needed).
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Agency Name:    (nonprofit, social service agency, school or other support provider name) *
Your Name: *
Your Email: *
Name of representative picking up the order:  (please bring agency ID, badge or business card for pick-up) *
Zip code where the CLIENT is living *
Provide as much client detail as appropriate to help us pack this order, it can be helpful to describe the need and the clients preferences.   Example:  6th grade student, loves sports   OR  Example: client is new at our shelter arrived with nothing except clothes on her back, she needs interview clothing and casual wear, does not like dresses!
What is the preferred gender style for clothing/shoe selection
Clear selection
Client approximate age:
Only complete the sections below that are needed for your client.   If an item is not needed leave that section blank.
Clothing Items:  Please list the clothing items that are requested with any style notes, size needed and quantity requested.  Example:  Shirts/casual/large/2, Shorts/elastic waistband/large, Jacket/light/large  
Undergarments: Please list the items requested and the sizes for each.  Example: bra/size 34a, underwear/medium, socks/no show/medium
Shoes:  Please list the type of shoe and size requested.  Example: athletic shoe/size12
Hygiene Goods:
Linens: sometimes in limited supply.
Twin
Queen
King
n/a
Sheets
Blankets
Towels
Baby blankets
Back to Work Items: Please check the Back to Work catalog to be sure we have the items needed before requesting.  List the item and size needed.
School supplies:  We generally have backpacks available year-round and often have school supplies at the start of the school year July-Sept. List what is needed.
Other needs we may be able to help with? (diapers, adult incontinence underwear, adult bladder pads, other)
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