Form

This form will connect you with the femly sales team. This form is not intended for the request of donations. If you have trouble submitting this form, contact us at sales@femly.com.

First Name*

Last Name*

Email*

Phone Number

How did you hear about femly?*

Does this location currently offer menstrual care? If so, what products?*

Menstrual Pads

Tampons

Wipes

No

Name of Organization*

Is there a best contact we should reach out to?*

Best Email Address*

How do you know this person?*

About how many restrooms are associated with this facility?*

Is there anything else we should know?*

Feel free to share more context on the organization you are nominating.