2. First Name*
3. Last Name*
5. Email address*
7. What would you like restocked?*

   1. Rack cards.
   2. We Scoop online pledge QR flyers.
   3. "I love clean water" stickers.
   4. Poop bags.
   5. Bag clips.
   6. Yard signs.
   7. Other.
9. If you checked other, please specify below:
11. How do you want to obtain your supplies?*

    1. I want my supplies delivered.
    2. I will make an appointment to pick up my supplies from the Whatcom County Public Works office.
13. If you would like your supplies delivered, please enter your address below.
15. Address1
17. Address2
19. City
20. State
21. Zip
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field