request for service - The WASH Foundation

FRESH START WASH & WELLNESS
REQUEST FOR SERVICE EVENT

Name of Organization*
Contact Name*
Contact Phone Number*
Contact Email Address*
Date of Event*
MM slash DD slash YYYY
Time of Event

: Hours

Minutes

AM/PM
Expected number of individuals needing shower services*
Location/address of event*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Purpose or nature of the event*