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Do you have a financial need?
Please help us to care for you by answering the following questions.
4
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1
Your Information
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Point of Contact
Name (First and Last)
Email
Phone Number
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Phone
Email
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Phone
Email
Best way to contact you:
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2
Tell us your story. How did you come to have this need?
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3
What amount are you requesting?
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4
Select the answer that best applies to you:
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I have received financial assistance from Vintage Grace before.
I have not received financial assistance from Vintage Grace before.
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