Household Items Request Form Please complete a form for EACH CLIENT. Agency Name * Contact Person Name * First Name Last Name State * Iowa Illinois Phone * (###) ### #### Email * Household Supplies Check if client needs the following: Towels Pillows Toiletries Dishes Pots & Pans Bedding Size Twin Full Queen King Additional Shopping Needs: Thank you for your request! Orders will be filled within a week of the date the form is received. We will contact you when it is ready for pick up.Items can be picked up on Wednesday or Saturday from 10-12.
