Application for Equipment Assistance Donate Apply "*" indicates required fields Step 1 of 2 50% Are you a First Responder?* Yes No Sorry, this application is for First Responders Only. Name*Date of Birth* MM slash DD slash YYYY Agency*Agency Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Cell Number*Email* Agency Director*May we contact your direct supervisor? Yes Supervisor Name*Supervisor Phone*Supervisor Email* Please briefly explain you need for Equipment Assistance with in your agency:*Today's Date* MM slash DD slash YYYY All requests are subject to approval by the FROM Board of Directors and may require further information and documentation from applicant or agency. All request are Confidential. Equipment Policy: All request for Equipment must be through the agency requesting the equipment. Equipment Request will not be considered for Individuals only. All request are confidential. Emergency Request: If your request is an emergency, please contact us immediately.
