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Furniture Donation Request
Please complete the following form thoroughly. A member of our staff will respond via the contact methods you provide.
Email address *
Furnishings for Disaster Relief
Name (First, Last) *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Last four digits of SSN# *
Your answer
Email Address *
Your answer
Current Address *
Your answer
City *
Your answer
State, Zip *
Your answer
Phone Number *
Your answer
Which agency were you referred by?
Your answer
Did your primary residence flood? *
If yes to flooding, what's your FEMA number?
Your answer
How many people are in your household?
Your answer
Our goal is to distribute items to as many families as possible. Each applicant is allotted ONE area of furniture or appliance. You cannot receive both areas. Please select ONE of the items listed below:
Our goal is to distribute items to as many families as possible. Please select the items you need the most. You may only select ONE of the items listed below.
I certify that the above information is true to the best of my knowledge. I understand if any of the above is not true I may forfeit my opportunity to receive furniture donations. *
Required
I understand that this application does not guarantee furniture or appliance availability. *
Required
I understand that applications are screened on a first come, first served basis. I understand that I am ONLY allowed furniture or an appliance. I understand that I cannot receive both items. *
Required
RELEASE OF LIABILITY I understand that the furniture through this program is for my personal use only. Donated furniture is not to be resold or used for commercial purposes. I understand that Volunteers of America Texas (VOA Texas) may share my personal information with its partner agencies for the purposes of coordinating distribution. I understand that, VOA Texas and its partnering agencies cannot guarantee what style and make of furniture is distributed. I UNDERSTAND THAT I AM RESPONSIBLE FOR PICK UP and that if I am not present within 30 minutes of my scheduled time, I will subsequently forfeit my furniture. *
Required
PHOTO/VIDEO RELEASE I give Volunteers of America Texas, its nominees, agents and assigns my free and unlimited consent and permission, waiving all claims for any compensation by reason thereof or for damages to use, publish,/broadcast, republish/rebroadcast or exhibit in the furtherance of its work, with or without identification of me by name. And to disseminate statements referring to me in conjunction therewith if VOA Texas so desires and to authorize any media, company, partner agency or organization to use, publish/broadcast, republish/rebroadcast or exhibit said photograph/video with or without identification of me by name to publish/broadcast or disseminate statements referring to me in conjunction therewith in the promotion of VOA Texas and any of its fund-raising campaigns or marketing materials. *
Required
I have read the above information and agree to abide by the terms contained within. By signing this application, I certify that the answers I have provided are true, complete and accurate to the best of my knowledge. *
Required
A copy of your responses will be emailed to the address you provided.
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