Complete form below to request an account. Once we review your information we'll email you a link to set up your account.

Program Name *

First Name *

Last Name

Email *

Phone *

Shipping Address: Line 1 *

Shipping Address: Line 2

City *

State/Prov/Region *

Postal/Zip *

Country *

Program Type *

Approx. Organization Budget (not inclusive of in-kind) * *

Does your project need fiscal sponsorship? *

Yes, we need support with administrative things like payroll and grant management
Yes, we need 501c3 umbrella status so that we are eligible or grants and charitable giving
I would like someone to reach out to me with more information about sponsorship.
No, we do not need fiscal sponsorship support.

Is your program exempt from state sales tax? *

Do you have a local sales and use tax exemption certificate? If so, attach a copy here.

This is not your 501(c)(3) letter of determination

Does your project need a physician to sign on for sterile water and naloxone purchases? *

Please attach a copy of your physician's license *

Sometimes folx reach out about partners programs or for services in their area. May we release information about your program to the following? *

By submitting this form, you're agreeing to receive emails from Points of Distribution. You can unsubscribe at any time.

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Please note: The marketplace has moved. You may place orders on this platform until October 31st.