REQUEST FOR SUPPLIES

By completing this form, you are confirming you have the authority to submit your needs on behalf of your organization and understand that we cannot guarantee all needs will be met.

Request Operational Supplies

Organization Name *

Are you a 501(c)(3) charitable organization? *

Yes

What counties does your organization serve? *

Clarion

Forest

Punxsutawney

Venango

Contact Name *

Contact Phone Number *

Contact Email Address *

In the field below, identify any operational and/or client supplies that your organization needs due to the COVID-19 pandemic. This can include any items for your ongoing operations or items to help you better serve your clients. Please include the supply name(s) and amount(s) requested. *

ALL AMOUNTS MUST BE INDICATED FOR A REQUEST TO BE ACCEPTED

Full address where items can be dropped off *

Days and Times items can be dropped off *

Is your mailing address the same as the physical address mentioned above? *

Yes

Mailing Address

Any additional comments or questions:

reCAPTCHA

ADDRESS

Headquarters
206 Seneca Street
National Transit Building Annex, 4th Floor
Oil City, PA 16301

CONTACT

Email: [email protected]

Phone: (814) 677-8687
Fax: 814-677-0653

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Trenton E. Moulin
President & CEO
Email: [email protected]

Lauren M. Lupinacci
Director of Finance & Operations
Email: [email protected]

Mishelle J. Beith
Development Manager
Email: [email protected]

Amy D. Mook
Program Coordinator
Email: [email protected]

By completing this form, you are confirming you have the authority to submit your needs on behalf of your organization and understand that we cannot guarantee all needs will be met.

ADDRESS

CONTACT

HOURS

Title