Material Order Form - Well Badger Resource Center

1. Agency Name

2. Which of the following priority populations does your agency serve? (Select all that apply) *This question is required.

Low income individuals or families
Pregnant people or new parents
Children and youth with special healthcare needs (including mental and behavioral health needs)
People with limited English proficiency

3. Contact Person *This question is required.

First Name

Last Name

4. Email address: *This question is required.

5. Mailing Street Address (ex: 1234 Main Street)

6. Suite # or Room # (if applicable)

7. City

8. State

9. Zip Code

10. Special Mailing Instructions

Please review our promotional print options below.

Fliers
Due to limited funding, we highly encourage you download and print our fliers.

Please 1) find the flier you would like and 2) click the bolded text below to view, download, and print.

Rack & Business Cards
Please choose the quantity for each item.

Please note there is a limit of 50 for each item. For larger quantities, please call the Partner line at 608-571-1481.

	English Business Cards
	English Rack Card (4 x 9 Brochure Size)
	English Flier (8.5 x 11)
	Spanish Business Cards
	Spanish Rack Card (4 x 9 Brochure Size)
	Spanish Flier (8.5 x 11)
	Hmong Business Cards
	Hmong Flier (8.5 x 11)

11. What is the best way to reach you (phone or email) if we have any questions about your order?