Moms Cookies

Requestor Information (* Indicates a required field)

* Full Name

* Email address

* City

* State

* Relationship to Service Member

* Referred By

(IE Internet, Service Member, etc.)

Service Member Information (* Indicates a required field)

Email address

Rank * Name 1 * Name 2

Use the 3 fields above to enter your rank and name exactly as it is needed to receive your mail. If your rank is not required, leave the first field blank.

Example 1: [SPC], [Bart L,], [Simpson]

Example 2: [SPC], [Simpson], [Bart L,]

Example 3: [blank] [Simpson], [Bart L,]

(**Note – APO, FPO and AE, AP, or AA Required )

* Address

Address

Branch of Armed Forces

Home State

Duty Type:

Date of Deployment

Est. Deployment End Date

Deployed Country Location

(**Assist in determining TYPES of items to send based on areas climates)

Comments/Requests

Male Personal Boxes Requested

Female Personal Boxes Requested

Buddy Boxes Requested

Gift Cards

Yes No

(If requesting card(s), AFFES must be available)

Phone Cards

Yes No

(If requesting card(s), AFFES must be available)

Gender

Male Female

OK to use Pictures

Yes No

**Note: Information of Requestor, Service Members/or Family Members is not released.
And protected by our Confidentiality Policy.

ALL INFORMATION IS CONFIDENTAL AND PRIVILEGED TO INCLUDE THE RECIPIENT! MOMS Confidentiality Policy does not allow for the release of Family nor Service Member Information without consent! This message contains information which may be confidential and privilege. Unless you are the addressee (or authorized to receive for the addressee), you MAY NOT use, copy or disclose to anyone this message or any information contained in this message. If you have received the message in error, please advise the sender by reply e-mail and delete or destroy the message.