Essentials First
Request Form for Essential items.
For additional assistance, please call 425-502-7768 or email
Bellevue Office Address: 919 124th Avenue NE, Suite 103 98005.
*We do not do deliveries. Please pick up the essential items and hygiene kits from our Bellevue Office

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Your First and Last name *
Role within the organization
Name of organization *
Organization street address
Phone number (org or contact person)
Contact person's email address
Organization Website (Note: Please provide a URL)
Please provide your social media handles
Postal Code(s) your organization serves *
Demographics of the people your organization serves *
Type of assistance needed *
Note: Personal hygiene kits include products, such as shampoo, soap, toothbrushes, laundry detergent, deodorant. etc. (full list of items can be found at
When do you need the Kits?
Reason for assistance *
Quantity of Essentials Kits *
Quantity of Street Kits *
Quantity of Warmth Kits
Quantity of World Food Kit (Culturally appropriate non-perishable food)
Type of food packages desired
Clear selection
Other kits/Items requested
Clear selection
Any other requests or remarks?
Clear form
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