Bottle Reservation Form

Fill out the form below to reserve baby bottles for your church or group! Please reach out with any questions.

Bottle Reservation Form

* Indicates required field

Primary Contact Name *

Church Name *

Contact's Phone Number *

Contact's Email *

Church Address *

Line 1

Line 2

City

State

Zip Code

Country

Church Phone Number *

BABY BOTTLES

Number of Bottles Requested *

Boomerang Start Date Requested *

Boomerang End Date *

Our church would also like to request: *

My Life Clinic General Information A representative to speak during a service Promotional slides, social media graphics, or flyers

BOTTLE PICK UP AND RETURN

When the bottles are picked up, we request that you check the total and sign that you received the correct number. When you return the bottles, please plan on allowing a few minutes for us to get a count of the total. If there are any outstanding bottles, we will give you a slip with the number of bottles missing, then we will check back with you in a few weeks to see if you were able to locate them. Replacement bottles cost My Life Clinic around $1.50 each, and we appreciate your effort to collect all the bottles borrowed to help us curb expenses.

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