Loan Closet Request Form

WebWhispers Member Information
Name*
First Last
Date You Joined WebWhispers.*
Month
Day
Year

You must be a member of WebWhispers to use this service. Please enter when you joined WebWhispers.
"Why do you need an EL at this time?"*
- I am a new laryngectomee and have not decided on a new voice and want to explore options
- I am an experienced EL user who needs a loan during replacement/repair/back-up of my own EL
- I am a family member/friend/caregiver of someone who needs an EL
- I am a SLP/healthcare provider advocating for a patient/client who needs an EL
- Other…please be specific in the box below.
If other is selected for your need for an EL please update here.
Address*
Due to the high customs/import duties, shipping and insurance costs, etc., the services of the WW Loan Closet is not offered to our International members. There are organizations abroad for those needing to borrow such equipment.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email
Otolarnygologist (ENT) or Speech-Language Pathologist (SLP) Information
Name*
First Last
Phone*
Product Information
What type of equipment do you need?*
How long will you need this equipment*
- 0-30 days
- 30-60 days
- 60-90 days
- 90+ days
Please let us know why you feel you will need this equipment for a period longer than 90 days.*
Normally, the loan period is 90 days or less, with some exceptions. Due to the high volume of requests WebWhispers needs to accommodate, there is no guarantee that we can permit the usage of this equipment for longer than 90 days.

You may also make these requests by sending an email directly to loancloset@webwhispers.org with the above information. This email address reaches all volunteer workers in the loan closet.

Loan Closet Request Form

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