Harmony Resource Partner Application

Business / legal company name

Business website

Business address (street, city, state, ZIP)

Contact person's name

Business email

Public business phone

Services offered (for example: pharmacies, home care, meals, wigs or mastectomy supplies, transportation, cleaning, caregiver respite, counseling, medical equipment or home accessibility)

States, counties or ZIP codes served

License / registration number, issuing state, and verification link (or explain not applicable)

Fees, insurance accepted, and any eligibility requirements

I represent this business and authorize Harmony to verify and publish these business details if approved. The listing is free for six months from publication; donations are optional and do not affect approval. Do not submit patient information.

Yes, email me Harmony Healing Foundation partner updates and occasional fundraising appeals. I can unsubscribe at any time. This is optional and does not affect my listing.

A copy of the current financial statement of Harmony Healing Foundation is available without charge by writing to 8659 Baltimore National Pike, Suite N, Ellicott City, MD 21043, or by calling (202) 937-2900. Documents and information submitted under the Maryland Solicitations Act are available, for the cost of postage and copies, from the Maryland Secretary of State, State House, Annapolis, MD 21401, (410) 974-5534. Registration does not imply endorsement.