2024 PHCC Disaster Relief Fund Request Form

2024 PHCC Disaster Relief Fund Request Form

The Disaster Relief Fund provides immediate assistance (up to $5000) to members in need as a result of flooding, storms, fires and other disasters, including a national pandemic. PHCC members may use these funds to offset costs to clean up structural damage, repair or replace equipment, maintain business operations, etc. All requests for assistance are confidential and will be considered on a first-come, first-served basis as funds become available.
Reason for the funds*
Amount Requesting*
Chapter
Name*

First NameLast Name
Company*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
REQUIRED: Documentation (photos, insurance claims, etc.)*

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File Upload

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File Upload

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NOTE: Recipients who are approved by the committee will receive their funds by check or Electric Funds Transfer (EFT).
Should be Empty: