Agency Application

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


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.

MM slash DD slash YYYY
Executive Director/CEO(Required)
Executive Director/CEO Email(Required)
Primary Contact(Required)
Primary Contact Email(Required)
Agency Address(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)