Partner Agency Request Form

Scroll down to fill out this form to request diapers for your agency to distribute to families in need.
Sign in to Google to save your progress. Learn more
Agency Information
Agency Name *
Agency Contact *
Who can we contact with questions about this request?
Phone number *
What's the best number to reach the agency contact?
Request delivery by (date) *
We cannot guarantee this date, but we'll do our best.
MM
/
DD
/
YYYY
Agency Request
Please indicate the number of diapers in each size that you are requesting. Packaging varies, so please request the actual number of diapers per size.

Please also indicate the number of individual wipes that you are requesting, not the number of packets. Although quantities per packet vary, an average packet contains 80 wipes. So, if you need 100 packets of wipes, you should request 8,000 wipes (100 x 80), not 100.
Is there anything unusual about this order we should know?
Preemie Diapers
Newborn Diapers
Size 1 Diapers
Size 2 Diapers
Size 3 Diapers
Size 4 Diapers
Size 5 Diapers
Size 6 Diapers
Size 7 Diapers
2T - 3T Pull Ups
3T - 4T Pull Ups
4T - 5T Pull Ups
Swim Diapers
Youth Brief / 65+
Wipes
Diaper Bank of Minnesota
The Diaper Bank of Minnesota items may not be sold, bartered or exchanged. Items received from the DBM may not be taken by volunteers, officers, clergy or employees for personal use. As outlined in the Internal Revenue Code Section 170(e)(3), all items you receive from The Diaper Bank must be used solely for the care of the ill, needy or minors, pursuant to the organization's charitable purpose.

Diaper Bank of Minnseota | 709 University Ave W., Saint Paul, MN 55104 | www.diaperbankmn.org
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.