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)NonprofitSchoolGovernmentOtherAgency's Annual Revenue(Required)0 - 500K5K - 1M1M - 1.5M1.5M - 2M2M or moreDate of Incorporation(Required) MM slash DD slash YYYY 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 AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agency Phone(Required)Agency Website(Required) # of clients your agency serves hygiene kits to annually(Required)0 - 100100 - 500500 - 10001000+Estimated Number of Kits Your Agency Needs Per Month(Required)2550100150200+Populations you'll serve with hygiene kits(Required)Individual adultsChildren / YouthFamiliesAgency 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