Request Supplies

CareOregon Supply Order Form

Please complete this form when requesting supplies for your department. Requests for supplies are processed during normal business hours and may take up to 7 to 10 business days to be delivered. Please plan in advance when requesting supplies for your department. DO NOT USE THIS FORM TO SEND ITEMS TO CLIENTS.
Supply Requester Information
Name*
First Last
Email*
Phone*
Department*
Delivery Information
Attn:
Company
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Special Instructions
Shelter Voucher and Meal Coupon Selection
Please enter the number of booklets or coupons that you are ordering for your department. Allow up to 7 to 10 business days for passes and/or vouchers to be delivered.
City Team Ministries Voucher Booklet(s) - 25 vouchers per booklet
Sisters of the Road Meal Coupons
Transit Pass Selection
Please enter the number of transit passes that you are ordering for your department. Allow up to 7 to 10 business days for passes to be delivered.
TriMet Adult 2.5 Hour Single Paper Tickets - Enter total number of individual tickets needed
TriMet Adult All Day Single Paper Tickets - Enter total number of individual tickets needed
TriMet Honored Citizen 2.5 Hour Single Paper Tickets - Enter total number of individual tickets needed
TriMet Honored Citizen All Day Single Paper Tickets - Enter total number of individual tickets needed
Trimet Youth 2.5 Hour Single Paper Tickets - Enter total number of individual tickets needed
Trimet Youth All Day Single Paper Tickets - Enter total number of individual tickets needed
TriMet LIFT 2.5 Hour Single Paper Tickets - Enter total number of individual tickets needed (please only enter multiples of 10)
TriMet Blank Adult HOP Cards - Enter total number of individual cards needed. These cards do not have any value loaded. You must make separate requests in CLARA for them to be loaded.
TriMet Blank Honored Citizen HOP Cards - These can only be used for clients who have already applied and been accepted into Trimet's Honored Citizen program, or are over the age of 65. Enter total number of individual cards needed. These cards do not have any value loaded. You must make separate requests in CLARA for them to be loaded.
TriMet Blank Youth HOP Cards - These can only be used for clients under the age of 18. Enter total number of individual cards needed. These cards do not have any value loaded. You must make separate requests in CLARA for them to be loaded.
Rogue Valley Transportation District - Single Ride Tokens
Rogue Valley Transportation District - Day Pass
Rogue Valley Transportation District - 20 Ride Pass
Rogue Valley Transportation District - 1 Month Pass
Cell Phones and Minute Cards
Please fill out this section when requesting additional cell phones and/or prepaid minute cards for your department. Please use CLARA to record or request phones for individual clients. Allow 7-10 business days for cell phones and prepaid minute cards to be delivered. Please plan in advance. If a specific phone or minute card brand is needed, specify below.
Flip Phones
Smartphones
Flip Phone Prepaid Minute Cards - $35.00
Smartphone Prepaid Minute Cards - $40.00
Supplemental $10.00 Minutes Cards to Cover Plan Price Increase (Only use this field if you have leftover phones that came with $30.00 cards)
If necessary, indicate the specific brand needed:
Notes/Comments
Please indicate any notes or comments about this order

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Request Supplies

CareOregon Supply Order Form

Supply Requester Information

Delivery Information

Shelter Voucher and Meal Coupon Selection

Transit Pass Selection

Cell Phones and Minute Cards

Notes/Comments