Chest Binder Request Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We are in partnership with Gc2b an organization that makes chest binders. They offer the chest binders to us for the cost of the postage it costs to mail them to us. We in turn want to offer these chest binders to those that are in financial need. A chest binder can cost at the very low end $35 and go upwards. We will give priority to those that are local to the central MN area.

Name *

Pronouns *

Address *

Phone *

Email *

Preferred Contact Method *

Phone Call

Text

Required

Delivery Method *

Pick Up

Mail

Drop Off

Do you have the financial means to pay for one? *

Yes

Style Preference: *

Tank

Racerback

Half Tank

Please specify below your color preference and we will do our best to accommodate.

Would you like assistance measuring for the correct Chest Binder size? *

Yes (Please contact me to schedule)

Yes (Currently being helped)

No (I will self measure)

Clear form

Never submit passwords through Google Forms.

This form was created inside of St. Cloud Pride. Report Abuse

Forms