DRESS FOR SUCCESS®
CINCINNATI

Suits to Self-Sufficiency
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Client Referral Form
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Program / Agency:
Contact Name:
Contact Phone Number:
Contact Email Address:
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DIRECTIONS:
The shop is located at 135 W. 4th Street between Race and Elm Streets. We are next to Koch’s Sporting Goods and Main Auction Gallery.
The phone number is 513-651-3372.
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Clients must be ON TIME or they will not be suited. No Children or Visitors ALLOWED!!
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Mr./Ms./Mrs.
Telephone:
Client First Name:
Client Last Name:
Address:
Apt:
City:
State:
Zip:
Social Security Number:
 - -
(Last 4 numbers are OK for now)
Date of Birth:
Ethnicity:
Other Ethnicity:
Marital Status:
Number of Children
Number in Household:
Does client receive public assistance?
 Yes No
Education Completed:
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Interview Suit
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Please help us maintain an adequate supply of various sizes by completing the following information:
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Suit Size:
Pants Size:
Shoe Size:
Blouse Size:
Skirt Size:
Outfit Preference: