C&S Voucher Request Form

This project is made possible by Western Dairyland EOC, a non-profit organization with funding sources which require us to collect demographic data. Your personal data will be kept confidential. If you have any questions, please contact us at 715-985-2391 or info@wdeoc.org. Thank you!

Household Information
Adults in household*
Children in household*
Estimated annual household income*
This information will be kept confidential and is used for statistical purposes only.
Do you own or rent your home?*
Notes
Someone from RSVP will contact you when your request has been processed. Vouchers can be picked up and used at Cents and Sensibility during normal business hours. (Tuesday, Thursday, Friday 10-4, Wednesday 10-6, 1st & 3rd Saturday 10-2).

In consideration for the privilege to distribute these materials, Western Dairyland E.O.C. shall be held harmless from any cause of action, claim, or petition filed in any court of administrative tribunal arising out of the distribution of these materials, including all costs, attorney’s fees, and judgments or awards.
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