SLIDING SCALE

SLIDING SCALE APPLICATION

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Name *

First Name Last Name
Email *
example@example.com
Date of Birth *

Day Month Year
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Why does using a chemical free towel matter to you? *
Have you applied for the TOWL low income program before? *

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If yes, what did you receive?
General Financial Information

Fill out the corresponding sections that best describes your situation.
How many immediate family members do you have? (spouse or children) *
Do you have a job? *

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Please upload a copy of your 2018 tax return *

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