Single Request Form

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Single Request Form

This form is for single product distribution AND disaster relief. Only those who are invited by Red.Lined or our partners should fill this form.

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* Indicates required question

Email *

Your email

Todays Date *

MM

/

DD

/

YYYY

Is the requestor living in North Providence, Pawtucket, Providence, Central Falls or Lincoln Rhode Island? If no, are you willing to commit to picking up and delivering the item(s) outside of the service area? *

Yes

No

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