Agency Application

Thank you! We value your commitment and appreciate your time.

NEW AGENCY APPLICATION/ 2020 UPDATE

Welcome! If you are a nonprofit organization, government agency, or school located in the Phoenix Metro area and would like to start receiving shoe box hygiene kits, please start the process by completing this form. Once submitted, we will review your application and reach out.

If you're using this form to update your agency information per our request, we thank you!
Please continue to place orders as usual.

Agency/School(Required)

Agency Federal Tax ID(Required)

Organization Type(Required)

Agency's Annual Revenue(Required)

Date of Incorporation(Required)

Executive Director/CEO(Required)

First Last

Executive Director/CEO Email(Required)

Enter Email Confirm Email

Primary Contact(Required)

First Last

Primary Contact Phone(Required)

Primary Contact Email(Required)

Enter Email Confirm Email

Agency Address(Required)

Street Address Address Line 2 City State ZIP Code

Agency Phone(Required)

Agency Website(Required)

# of clients your agency serves hygiene kits to annually(Required)

Estimated Number of Kits Your Agency Needs Per Month(Required)

Populations you'll serve with hygiene kits(Required)

Agency Mission Statement(Required)

Some agiencies will be required to pay an ANNUAL admin fee which is calculated based upon the average number of hygiene kits you anticipate ordering per month at a rate of $2/ box.

This fee can be paid in installments online, via check, or bank transfer.

Further details will be sent to you upon your agency's approval for our program.

On behalf of my agency, I agree to the terms of the Shoebox Ministry Agency Agreement(Required)

I agree

Our agency is experiencing financial hardship and would like to request a fee reduction or waiver