Container Request Form

Name of Organization (required)*

Website (ex: http://www.medministries.org)

Address of your Organization (required)*

Street Address Address Line 2 City State ZIP Code

Contact Person (required)*

Email (required)*

Phone Number (required)*

Is your organization a registered U.S. non-profit?

Please provide some information about your organization.

Please provide 2 references with contact information*

Please provide information regarding who will benefit from the products that are distributed:

Does your organization have experience with container shipments?

What are the required tax-exoneration certificates and/or other paperwork necessary to clear customs duty-free?

What Kind of Animal says "Meow"*

FULL SHIPMENT REQUEST FORM