All-Gender Restroom Sign Request Form

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The Office of LGBTQ Affairs is offering complementary all-gender restroom signs to small businesses in Santa Clara County. Small business is defined for these purposes as any entity with 99 employees or less. Business owners may request up to 2 door signs and 2 wall signs only. Signs are offered on a first come, first serve basis, while supplies last. Additional signs will not be purchased by the county.

Please fill out this form completely.

Company/organization name *

Contact name *

Contact phone *

Contact email *

Street mailing address (the best location for mailing the signs) *

City *

State *

Zip Code *

Street address for the physical location of the business (if different from the mailing address):

City (if different from the mailing address):

State (if different from the mailing address):

Zip Code (if different from the mailing address):

How many employees does your business or organization currently have? *

0-4

5-35

36-99

For these next questions, please let us know what kind of signs and how many you need. Each stall requires an all-gender DOOR sign (triangle on top of a circle.) Designation signs on the wall (Rectangle sign with text) are not required by CA code but is recommended. Note: If your restroom is also wheelchair accessible, you will need to purchase or supply your own ISA sign.

Please indicate the number of triangle signs requested. *

No triangle-in-circle door signs needed (please note: these are required for all single stall restrooms)

1 sign requested

2 signs requested

Please indicate the number of "All-Gender Restroom" text/braille signs requested. *

No text/braille wall sign required

1 sign requested

2 signs requested

To receive your signs, please agree to each item below by placing a check in the box. *

I confirm this is a small business (99 employees or less) in Santa Clara County.

I agree to use this sign at the business location listed on this form.

I will not sell this sign to another entity or business.

Required

Join the Office of LGBTQ Affairs mailing list. *

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Questions or comments

Thank you for requesting all-gender restroom signs from the Office of LGBTQ Affairs.

You should receive your signs within 2-3 weeks. If you do not receive it by then, please contact LGBTQ@ceo.sccgov.org or call 408-678-2900. For more information about the signs and related laws, please visit: https://www.sccgov.org/sites/lgbtq/Our-work/programs/Pages/All-Gender-Restroom-Signs.aspx

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