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Shelter In Place Assistance - CCOC
Please provide your contact info & how we may assist you during this difficult time.
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First & Last Name
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Email
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Your answer
Address (street address, city, state, zip)
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Phone Number (we will use this number to contact you)
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How may we serve you (you can select multiple options)?
Communion Delivered To My House
Groceries Delivered To My House
Pharmacy Needs Delivered To My House
Other (please provide details below of how we may assist you)
If other, please provide details of how we may serve you.
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