2-1-1 Materials Request Form
United Way 2-1-1, serving Lucas, Wood and Ottawa counties is happy to provide 2-1-1 materials for local agencies and businesses. Please provide information about materials needed. We will confirm receipt of your request via phone/email and verify pick up date. All materials can be picked up at one of our three locations (Toledo, Bowling Green, or Port Clinton offices).
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Contact Name *
Organization Name *
Contact Email *
Contact Number *
Date Materials Requested *
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Date Materials Needed *
MM
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YYYY
Number of Posters
Number of Rack Cards (Front English, Back Spanish)
Number of Business Cards
Number FamilyWize Prescription Cards
Translated materials: Any above items in Mandarin, Arabic, or Spanish
Pick-Up Location *
Any Additional Notes:
Submit
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