Shoe Bank Canada Request Form
Your Name
Is this request on behalf of an organization?
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Organization Name
Organization Website
Email
Phone #
Province or Territory
Address
Type of Men's shoes you require
How many Men's shoes do you require? (Please Specify by Type)
Type of Women's shoes required
How many Women's shoes do you require? (Please Specify by Type)
Type of Children's shoes you require
How many Children's shoes do you require? (Please Specify by Type)
Comments
Please note that specific size requests can only be accommodated for orders less than 20 pairs, otherwise please provide a general range of sizes.
Date shoes are needed by
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If over 1 month please provide an expected date
MM
/
DD
/
YYYY
FOR OTTAWA REQUESTS ONLY. Are you able to pick the shoes up at any of the following DYMON locations?
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