601 For Period Equity Menstrual Product Request Form

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601 for Period Equity's mission is to uplift Black menstruators and fight period poverty in the state of Mississippi. If you live in Mississippi and need access to menstrual care supplies, fill out the form below for products shipped to your doorstep!

Are you a school, shelter, or another community organization looking to provide menstrual products to those you serve? Fill out the form or contact us via email to request supplies!

Questions or Concerns? Send us an email or message via social media:

IG: @601forperiodequity
Twitter: @601period
Facebook: 601 for Period Equity
Email: 601forperiodequity@gmail.com

Email *

Are you an organization or an individual requesting supplies? *

Organization

Individual

Name *

Phone Number *

Address (street name, city, state, zip code, etc.) Please provide a physical address (No P.O. Box) *

Where in Mississippi are you located? *

What products are you in need of? Select all that apply. *

Tampons

Pads

Menstrual Hygiene Wash

Wipes

Panty liners

Midol (menstrual pain relief medicine)

Other:

Required

If you feel comfortable sharing, do you or your organization have any other needs?

other hygiene items (deodorant, soap, toothpaste, toothbrush, etc.)

groceries

PPE (mask, hand sanitizer, etc.)

clothing

baby items (formula, diapers, etc.)

Other:

Additional questions, comments, or concerns

Send me a copy of my responses.

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