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Community Unity Network Resource Center of Pitt County, Assisting government and non-profit agencies with Emergency relief and disaster services
Agency Form Please Fill out all information
Date
Agency Name
Address
City
State
Zip
County
Are you a 501c3
Yes
No
Director or Pastor Full Name
Pick up person full name
Telephone
Email
Order Form
1.Products
Hand Sanitizer
Face mask
Sanitizer Wipe
Cleaning Supply
other
other
1.How many
2.Product
Hand Sanitizer
Face mask
Sanitizer Wipe
Cleaning Supply
other
other
2. How Many
3. Product
Hand Sanitizer
Face mask
Sanitizer Wipe
Cleaning Supply
other
Other
3. How many
4.Product
Hand Sanitizer
Face mask
Sanitizer Wipe
Cleaning Supply
other
Other
4. How many
5.Product
Hand Sanitizer
Face mask
Sanitizer Wipe
Cleaning Supply
other
other
5.How Many
Authorized By
Rev.Dr.Rodney Coles Sr
Pam Collin
Valarie Walker
Robert Williams
Debra Coles
Do not enter anything in this field:
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Community Unity Network
Greenville, North Carolina 27834
252 296-1237
cunetwork2015@gmail.com
https://bmr2016.com/