Mission Trip Request Form

Please fill out all parts of the form below to complete a request.

Step 1 of 5

Your Contact Information
Team Leader Name:*
First Last
Team Leader Address:*
Street Address City State Zip Code
Team Leader Phone:*
Team Leader Cell Phone:
Team Leader Email:*

About Your Mission
Shipment information: You must select dates greater than 3 weeks from today. Leave a message in the comments box at the end of the form if you need your order sooner. Expedited orders will be charged an extra $200 for processing plus the expedited shipping charge.
Receive Your Medicines By:*
MM slash DD slash YYYY

(Your order will arrive no later than the entered date)
Leave for Mission:*
MM slash DD slash YYYY
Return from Mission:*
MM slash DD slash YYYY
How many people going on trip?*
Select mission trip country:*

Shipping Information
You cannot change this shipping address unless you email us during business hours before you order. PayPal asks you to enter a shipping address when you pay for your Kingsway order but we will only use the address below to ship.

Please give us the Physical Address and Phone Number for package delivery or enter "Will Pick Up" in the address field and in the comments box if you are picking up your order.
Ship To Person Name:*
First Last
Ship To Phone:*
Shipping Address:*
Street Address Address Line 2 City State Zip Code
Shipping Address Is:*
Additional Comments
Shipping Terms and Conditions:
Shipping as defined by Kingsway Charities includes the actual shipment of the order from our facility to the address you provided. Each customer will be responsible for any additional charges for services requested at time of delivery. These include inside delivery, use of a lift gate or change of address for delivery and re-delivery. These are charges by the freight company, not additional charges from Kingsway.
Please check your spam and trash folders if you don't see an expected Kingsway email in your inbox.

Notes about the Mission Trip Request Form:

The Team Leader is the name of the person leading the team for this trip. We create a file for this trip identified with the team leader’s name, and all the correspondence about the trip is addressed to that person. If we have questions, we’ll call that person first. Any questions regarding this trip should be made with reference to the team leader’s name or the trip ID number.

The Physician with your Organization/Ministry is the Doctor listed with your organization/ministry and who has sent us a copy of his/her current license and accepts responsibility for the medications and medical supplies for your mission trip.

The Pack Date is optional for those who need to pack or receive paperwork earlier than a week before the trip date. You may give us a pack date that is two or three weeks before your trip, or even several months before you leave on your trip.

The Pack Date, Trip Date, and Return Date must be greater than 3 weeks from the current date.

Country of Mission is the destination country for your trip. It is helpful if you also include the city or district of your destination.

Shipping Information should be the physical address and person the medications for this trip should be shipped to. This can be the team leader, but can be anyone else the team leader designates. Trucking companies do NOT accept P.O. Box numbers for shipping as a delivery address. The phone number is also important – some truck lines will not deliver without it.

Mission Trip Request Form

Step 1 of 5

Your Contact Information

About Your Ministry

Advising Physician

About Your Mission

Shipping Information

Please check your spam and trash folders if you don't see an expected Kingsway email in your inbox.

Notes about the Mission Trip Request Form: