SLIDING SCALE

SLIDING SCALE APPLICATION

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Name*

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

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState / Province

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

YesNo
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?*

YesNo
Please upload a copy of your 2018 tax return*

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Date*

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