ReUse Equipment Request
Please expect contact within 14 business days of the ReUse Request submission. Requests will be contacted based on a first-come, first-serve basis via the form only. Please do not call or email staff with item requests. If items are to be shipped to an individual, ATLA will cover the cost of shipping up to $20.00. *This form is only a request; equipment is not guaranteed.*
Name (required)
*
First Name
Last Name
Email (required)
*
example@example.com
Contact Number (required)
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address (required)
*
Mailing Address
Mailing Address Line 2
City
State / Province
Postal / Zip Code
Primary Area of Use (required)
*
Community Living
Education
Employment
Requested Equipment
Please describe the individual’s needs or provide information that may be useful for ATLA specialists.
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