PowerMax Company Birthday Hope Gift Request

I understand that PowerMax Company Birthday Hope Gift Request is for families who are in need. I understand that I must select one of the options below regarding my family size and income. I understand that the Birthday Hope Request must be submitted 30 days prior to my childs birthday to be considered. By checking this box, I am stating that I understand and agree to the requirements, I am a family that is in need, and that the need is for my child/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), Proof of Birth/Birth Certificate, and a Government Issued ID.) *

I understand and I agree
N/A

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), Proof of Birth/Birth Certificate, and a Government Issued ID.) *

I understand and I agree
N/A

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), Proof of Birth/Birth Certificate, and a Government Issued ID.) *

I understand and I agree
N/A

Parent's Name *

First

Last

Child's Name *

First

Last

Child's Date of Birth *

Child's Age *

Contact Number *

Email *

Confirm Email

Enter Mailing Address *

I understand and agree that selections are made by a lottery system and there is no gurantee that my child will be selected. *

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? *

If selected, someone from PowerMax Company will contact me to arrange pickup of the gifts. *

I understand and agree

Phone