Request Supplies

Health Share 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 passes for your department. DO NOT USE THIS FORM TO SEND ITEMS TO CLIENTS.

  • Supply Requester Information

  • Delivery Information

  • Shelter Voucher and Meal Coupon Selection

    Please enter the number of booklets or coupons that you are ordering for your department. Allow 3 to 4 business days for passes and/or vouchers to be delivered.
  • Transit Pass Selection

    *UPDATE* Trimet has discontinued the pink foil-stamped paper tickets and will no longer be accepting them after December 31st, 2019. They have fully transitioned over to the HOP program and have replaced the pink ticket booklets with single use paper HOP passes. As the booklets are no long available, please enter the number of single use passes that you are ordering for your department.
  • 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.
  • Notes/Comments