Delivery Request
Please feel free to fill out this form on behalf of a parent, grandparent, friend or other relative who needs help. Also include your contact info if you’d like us to confirm with you once we’ve delivered their items.
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Email *
Full Name *
Phone Number (include area code) *
Street Address *
To use our service, please confirm that at least one of these statements apply to you (check all that apply to you): *
Required
How would you like to pay for your order? *
Required
What store(s) would you like the volunteer to buy your items from? Write 'flexible' if you do not have a store preference. *
Anything else you would like us to know?
Please be advised, we’ll deliver your items as soon as possible, but as a volunteer-based service, our resources are limited. We assume no liability for incorrect orders, late deliveries, or theft. We anticipate smooth sailing, but there’s always risk of human error. In completing this form and checking the box below you agree that we are not liable for any mishandling. *
Required
I have read Helping Hands Delivery's protocols and agree that neither Helping Hands Delivery nor any of its volunteers or affiliates are liable for theft, fraud, contagion, or disclosure of any private medical information or other confidential information. *
Required
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