The Kindness Revolution (Short) Form
Best way to contact you (Phone, Email)
Number of Bracelets
What will the Bracelets be used for?
Where Do You Pick Them Up?
You can pick the bracelets up at Bill Quickel's - Insurance Plus Agencies office at 114 COURT STREET POMEROY, OH 45769 Our phone number is 740-992-6677 and our email is
Hours of operation are Monday-Friday 9am-5pm
Thank you for your interest!
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service