Individual Request Form

Individual Request Form 2018-01-17T09:52:22+00:00
Individual Request Form
Once you have placed your request please allow 2-4 business weeks to receive your package. Once your package is shipped you will receive a tracking number to the email provided in your request. If you have not received your beauty bag or tracking number within 4 weeks of your request you may contact our offices directly. PLEASE DO NOT SUBMIT MULTIPLE REQUESTS

Individuals can only receive one beauty bag every 6 months

The Breast Cancer Charities of America/iGoPink is unable to ship outside of the United States

Document Verification

Please submit a relevant piece of medical documentation verifying breast cancer diagnosis, treatment, or survivor status.
Drop a file here or click to upload Choose File
Maximum upload size: 134.22MB

Contact Verification

Please list the contact information for a person who can verify the recipient has been affected by breast cancer in their lifetime.