PTS "GIVES BACK" Program
Positive Transition Services strives on giving back to the community by way of various financial supportive assistance. This form is created for the sole purpose of tracking and submitting requests from the Giving Back fund built solely off of fundraising efforts. Below are questions that must be answered. Please complete this form in its entirety. PTS reserves the right to approve or deny requests submitted. Please understand, we make every attempt to assist those in needs so long as funds are available for disbursement. Process takes 14-days to process.
Email address *
Please type the First and Last name of the person in need of assistance. *
Your answer
Enter your phone #. If you do not have a phone number for us to reach you type N/A. *
Your answer
Enter your email address. If you don't have an email address type N/A. We must have at least a phone number or email address to reach you. *
Your answer
GIFT CARDS: Please click the box for the type of gift card being requested. If not requesting a gift card click the "N/A" box. Note, you can select more than one box? Gift cards will not exceed $100. *
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Required
FINANCIAL SUPPORTIVE ASSISTANCE: Please select the type of assistance you are requesting by clicking the box or boxes. If you're not requesting any financial assistance click the "N/A" box. Note, verification is required and must be faxed to 1.888.900.9408 or emailed to ptsinfo9@gmail.com within 72 hours of submitting this form. You can select more than one choice, however, verification of bill or invoice is required. *
Required
Enter the name of the business to be paid (must match bill or invoice being submitted). Type N/A if you don't need to enter an answer here. *
Your answer
Name on the account or being paid for who? (must match bill or invoice being submitted). Type N/A if you don't need to enter an answer here. *
Your answer
Account # or Invoice #. Type N/A if you don't need to enter an answer here. *
Your answer
Due Date: *
MM
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DD
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YYYY
Amount being requested for payment? Type N/A if you don't need to enter an answer here.
Your answer
Reason for request from the GIVES BACK supportive assistance program? Click the drop-down box to select your answer. You must select a reason. *
Enter the name of the business to be paid (must match bill or invoice being submitted).Type N/A if you don't need to enter an answer here. : *
Your answer
Name on the account? (must match bill or invoice being submitted).Type N/A if you don't need to enter an answer here. *
Your answer
Account # or Invoice #. Type N/A if you don't need to enter an answer here. *
Your answer
Due Date: *
MM
/
DD
/
YYYY
Amount being requested for payment? Type N/A if you don't need to enter an answer here.
Your answer
Reason for financial supportive service? Click the drop-down box to select your answer. If not requesting a second financial assistance request select N/A. *
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