UMCOR Relief Network

UMCOR Relief Network

Request for Domestic Relief Supplies
There are two sections, one for the organization requesting the supplies and the other for the organization that will receive the supplies. If the requesting organization is the same as the receiving organization, fill in the same information in the received field as the first.
Organization Filling out Request (i.e. Conference Office, Disaster Relief Coordinator, Methodist Church) or Non-profit*
NAME of person filling out form*

First NameLast Name
Contact Person TITLE*
Contact Person EMAIL*
example@example.com
Contact Person CELL Phone Number*
Organization filling out the form ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Kit Delivery or Pick-Up

Delivery and pick-up details will be discussed when you receive a call from the Depot who will be gifting you the supplies. Delivery is not guaranteed for non-disaster response requests.
Are you requesting to pick-up or have these items delivered. Delivery is not guaranteed. *
Select one option
Type of disaster or need*
Requested date of Pick-Up or Delivery*

MonthDayYear
Date
Which Depot is closest to you?*

Missouri Annual Conference - Colombia, MissouriNorth Alabama Disaster Relief Warehouse - Decatur, AlabamaUMCOR Sager Brown - Baldwin LouisianaDisaster Response Center - Kerrville, TexasTexas Annual Conference Mission Center - Conroe, TexasMission Central - Mechanicsburg, PennsylvaniaEastbrook Mission Barn - New Castle, PennsylvaniaMidwest Mission Distribution Center - Pawnee, IL
UMCOR Relief Supplies
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UMCOR Hygiene KitsHygiene Kits Requesting? (24 kits to a box) Request in multiples of 24
$ Free Quantity

UMCOR Cleaning KitsCleaning Kits requesting? (36 kits to a pallet) *These may only be requested in response to a natural disaster.
$ Free Quantity
Off Loading Requirements and Responsibilities:

Delivery organization and location must arrange for volunteers/staff to off-load the shipment. Volunteers/staff must be at the site before the scheduled arrival time. Kits will be delivered by semi-truck, or a truck and trailer, so consider this when selecting a location. The exact time of vehicle delivery will be told to you before the date scheduled.
Organization Receiving Supplies*
Receiver Contact Person*

First NameLast Name
Receiver Contact CELL Phone #*
Receiver Contact Person EMAIL*
Receiver Address*

Street Address

Street Address Line 2

CityState

Zip Code
Additional Information
A depot staff member will contact you to discuss your application.
Should be Empty: