Ramp Request Form

Your name *

Email address *

Phone number *

Are you the Ramp Recipient? *

Are you or the recipient a member of Rich Fork Baptist Church (*Not a requirement to receive a ramp.) *

Address for Ramp *

Date Ramp is Needed *

Describe the need: *

(For example, upcoming surgery, temporary recovery, permanent disability, etc.)

Own or renting the residence? *

Ramp type being requested: *

Please measure the distance from the ground to the threshold of your door and enter that value in inches: *

Please take pictures of the front of the house that shows where the ramp would need to be installed, including the area where it approaches the driveway.

Click here for example of photo needed.

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Add up to 5 files. Maximum file size 10 MB.

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