Depot Supply Form

Depot Name*

Contact Name*

First NameLast Name

Is this an urgent request? (i.e. is your freezer full)

YesNo

Please describe:

Would you like a call back?

YesNo

After submitting this form you can also email us at milkdepot@themilkbank.org. If this is an urgent request please call 317-536-1670 and ask to speak to Jami, please ask our operator to interrup if needed.

Do you need dry ice?

YesNo

Do you need Ice packs?

YesNo

For how many boxes/coolers do you need dry ice?

For how many boxes/coolers do you need ice packs?

Do you need return shipping labels?

YesNo

How many shipping labels do you need?

Do you need a UPS pickup scheduled?

YesNo

Pickup instructions:

Medium Cooler Boxes

Each cooler will come in a cardboard box, will hold up to 150oz and will contain instructions and a pre-paid return label. Enter the number of medium cooler boxes you would like.

Large Cooler Boxes

Each cooler will come in a cardboard box, will hold up to 300oz and will contain instructions and a pre-paid return label. Enter the number of large cooler boxes you would like.

Do you have preferred days to receive coolers? Be sure to let us know if there are days you are closed and cannot receive supplies. Please let us know below:

Freezer Bags

Freezer bags come in packs of 100. Enter the number of packs you would like.

Donor Follow Up Cards

These are the follow up cards for donors, there are four per sheet.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Optional – Please share any additional feedback or information with us here (i.e. interested in being featured in our newsletter or holding a milk drive).

Standard Milk Bank Brochures, English

Brochures come in packs of 25. Enter the number of packs you would like.

Bereavement Milk Bank Brochures, English

Brochures come in packs of 25. Enter the number of packs you would like.

Standard Milk Bank Brochures, Spanish

Brochures come in packs of 25. Enter the number of packs you would like.

Bereavement Milk Bank Brochures, Spanish

Brochures come in packs of 25. Enter the number of packs you would like.

Milk Depot Supply Request