Dupage County TFT Toy Request Form
Contact Information
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Organization |
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Point of Contact |
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Street Address |
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City ST ZIP Code |
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Phone |
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Fax |
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E-Mail |
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Number of Toys Requested |
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Please note:
- Limit
one toy per child.
- You
must be a federally recognized non-profit organization with a 501(c) 3
form in order to qualify, not just a State tax exempt. Please send a
current copy of this form along with your toy request.
- Forms
can e-mailed, faxed, or mailed in to contact info listed below.
- When
your request has been approved and completed we will contact you with a
confirmation number and will coordinate a date/time to pick up your order.
- Due
to the very high demand you will have one week to pick up your toys from
the time you are contacted or they will be given out to another
organization.
The above information is true and correct to the best of my knowledge.
Print
FULL NAME: __________________________________
Sign:
____________________________________________
Date: ____________________________________________
Dupage
County MCL TFT Warehouse is located at:
C/O Midwest Brachytherapy
920 N. Ridge Ave. Suite C-5
Lombard, IL 60148