Financial Assistance
Dear families of special needs children,

We understand that for some families it is financially difficult to afford a product such as the Power Pumper. We also know the benefits of having a Power Pumper for use at home and how it changed the lives of so many children. Therefore, the staff at Columbia-Inland has worked hard to identify non profit groups and other agencies that can assist with the cost of buying this product. Several groups nationwide have purchased Power Pumpers for special needs families. Your family may qualify as well! If you would like us to put you in touch with an agency that may be able to assist you, please fill in the fields below. We will contact you with some resources. We strongly believe that every child deserves to be mobile, have fun, and use a Power Pumper at home! We can not guarantee that any of the organizations we refer you to will in fact assist you, however, it is worth a try. Good luck!!

Note:   This information is confidential and is to be used solely by Columbia Inland Corporation. It will not be sold or distributed to any other parties.
Please fill in the information below.
FIRST NAME: *
LAST NAME: *
MAILING ADDRESS: *
City: *
State: *
ZIP: *
EMAIL ADDRESS: *
PHONE NUMBER: *
CHILD'S DIAGNOSIS: *
AGE OF CHILD: *
OPTIONAL FIELDS:
Has your child used the Power Pumper at therapy or school?
YES NO
If no, how did you hear about the Power Pumper?
Columbia-Inland Corporation
606 15th Street
Oregon City, OR 97045
Phone:
Toll Free:
Fax:
E-mail: 		503.657.6676
888.215.7867
503.722.2962
info@powerpumper.com