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).
Contact Name *
Organization Name *
Contact Email *
Contact Number *
Date Materials Requested *
MM
/
DD
/
YYYY
Date Materials Needed *
MM
/
DD
/
YYYY
Number of Posters
Number of Rack Cards (Front English, Back Spanish)
Number of Business Cards
Number FamilyWize Prescription Cards
Pick-Up Location *
Any Additional Notes:
Submit
Never submit passwords through Google Forms.
This form was created inside of United Way of Greater Toledo. Report Abuse