This Christmas Gift Request Form 2022

I understand that PowerMax Company Gift Request is for families who are in need. By checking this box, I am stating that I am a family that is in need, and that the need is for my children only. *

I understand and I agree

I am a family of 1-2 children with an income lower than $25K annually, and I will provide proof of income (Paystub or Unemployment Statement), and a Government Issued ID.) *

I understand and I agree

I am a family of 3-5 children with an income lower than $35K annually, and I will provide proof of income (Paystub or Unemployment Statement), and a Government Issued ID.) *

I understand and I agree

I am a family of 6 or more children with an income lower than $45K annually, and I will provide proof of income (Paystub or Unemployment Statement), and a Government Issued ID.) *

I understand and I agree

Name *

First

Last

Contact Number *

Email *

Confirm Email

Enter Mailing Address For Gifts To be Mailed *

How many children need need gifts? *

Select the amount children that you have, that is in need of gifts.

List the gender, age, size for clothes and shoes, any important information that you would like to share regarding what is needed the most. *

Example: Boy 5 years old and wears a 5T in pants and shirts, he wears a 13 in shoes. Girl 2 years old and wears 18 months in clothes and wears a 6 in shoes. My son that is 5 years old needs pants the most, my 2 year old daughter needs shoes the most.

Do you live in Prince William County? *

Prince William County residence will have preference over other counties, however we will do our best to service as many families as we are able outside of Prince William County.

Christmas Gifts Will Be Mailed To The Mailing Address Provided By December 17th, 2022 *

I understand and agree