Partner Diaper Request Form

Diaper Bank Partner Request Form
Hello Diaper Bank Partners!

Hello Partners! A few important things to keep in mind when ordering: Diaper requests are fulfilled once a month as long as we have resources, and are typically shipped the first week of the following month--however we are a small volunteer organisation so we appreciate your patience. Partners organisations can request up to 10 boxes total. If multiple orders from one organisation are submitted, we will spread the 10 evenly across all requests. Please note: we pause our deliveries during the months of July and August and resume again in September. Any request made in those months will not be fulfilled. Any questions? Don't hesitate to get in touch: info@thediaperbank.ca. We look forward to getting you the diapers that you need! Have a great day!
Organization Name
Contact Person
Phone Number
Email Address
Address (Please note: diapers must be delivered to a Partner address--we CAN NOT ship to clients directly)

Street Address

Street Address Line 2

CityProvince

Postal Code

How many boxes per size are you requesting? YOu can request up to 10 total boxes

Rows	Quantity of boxes
Newborn
Size 1
Size 2
Size 3
Size 4
Size 5
Size 6
Size 7
Pull Ups 2-3T
Pull Ups 3-4T
Pull Ups 4-5T
Pull Ups 5-6T
Pull Ups 6-7T

Total boxes requested
Additional Notes
This request adds up to more than our 10-box maximum. Please adjust the quantities above to total 10 or fewer in order to submit.
Mailing address Please include street, city and postal code and any necessary delivery instructions.
If you are able to share - if we cannot provide diapers at this time, what will your client do?

Please provide information for each child requiring diapers. You may only request one size per child. If requesting Pull-ups, please include full details on size (3-4T, 2-3T, etc) and gender if relevant.

Rows	# of parents in home	Age of Child	Diaper Size
Child 1
Child 2
Child 3
Child 4
Child 5
Child 6
Child 7
Child 8
Child 9
Child 10

Should be Empty:

Diaper Bank Partner Request Form

Hello Diaper Bank Partners!