Or Submit a Completed Application
Or download a printable copy of this form here and submit below. Click on the form above.
Please complete this application in one sitting. Changes made to this form cannot be saved and will be lost if page is refreshed.
Please review entire form for required fields before submitting. If you have any technical difficulties or have any questions, please call 701-212-1921 or TF 888-524-2827.
Legal Statement The medical supplies, equipment and materials available from HERO, Healthcare Equipment Recycling Organization (here on as “HERO”) are items that would otherwise be discarded from healthcare facilities and or/providers and individuals. These materials are made available on an “as-is” basis for the use of humanitarian relief through your organization. HERO and any donating facilities of supplies and equipment do not represent, warrant or imply that such materials are free of defects or suitable for any purpose. Each recipient organization, sponsor and recipient facility assumes full responsibility for making independent determination of the appropriateness and use of each item before using it. By submitting an application for the receipt of supplies, each organization, sponsor and recipient facility releases HERO, its board members, donors and employees from all responsibility, claims, costs and liability associated with the materials.
MISSION SUPPLY APPLICATION