Milk Drop Supply Order Form
Milk Drop Location
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Street Address Line 2
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Contact Person
*
Prefix
First Name
Last Name
E-mail
Phone Number
-
Area Code
Phone Number
Supply List
Becoming a Milk Donor Card - English (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Becoming a Milk Donor Card - Spanish (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Becoming a Milk Donor Rack Card - English (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Becoming a Milk Donor Rack Card - Spanish (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Bereavement Brochure - English (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Bereavement Brochure - Spanish (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Inpatient Milk Recipient Rack Card (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
Inpatient Milk Recipient Rack Card - Spanish (25 cards per set)
$
Free
Quantity
0
1
2
3
4
5
Outpatient Milk Recipient Rack Card (25 cards per set)
$
Free
Quantity
0
1
2
Outpatient Milk Recipient Rack Card - Spanish (25 cards per set)
$
Free
Quantity
0
1
2
12x12 Shipping Boxes (Bundle of 25)
$
Free
Quantity
0
1
2
3
4
5
12x12 Liners (silver tubes) (case of 20)
$
Free
Quantity
0
1
2
3
4
5
Clear Plastic bags Liners (bundle of 25)
$
Free
Quantity
0
1
2
3
4
5
Prepaid FexEx AirBills (Bundle of 10)
$
Free
Quantity
0
1
2
3
4
5
Multi-Piece Ship Labels (Pink Slip) (bundle of 10)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
Perishable Labels (25 Labels)
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
"I Donated Milk Today" Sticker
$
Free
Quantity
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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50
Special Instructions
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