Buck - Title "Scrapline Buck"

Name*

First Name Last Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Which office would you like to pick up at?*

We can accept any of the following payment methods, which would you prefer?*

MasterCardVisaAmex

Do you have any questions or special requirements?

Notes to Alicia / Pamela before they contact me.

Again, Alicia or Pamela from Community Care in Peterborough will be in touch with you shortly to complete your order.

If you have any questions, please contact Alicia at 705-742-7067 ext. 224

Community Care Peterborough will protect your privacy. The Personal Information provided by you in this Form is collected and used by Community Care Peterborough for the purpose of processing your request to buy goods. By completing this form, you are consenting to Community Care Peterborough collecting personal information necessary for the provision of goods to you in accordance with policy CLI-1-22. You have the right to refuse to share your information with Community Care without being denied service. Please contact us if you wish to receive a copy of our Privacy Policy. Community Care Peterborough - 705-742-7067 or privacy@commcareptbo.org

“Scrapline Buck”