UNITY Warehouse Requisition Form
For UNITY and our partner organizations to request household goods and furniture for recently-housed, formerly homeless folks.

UNITY Warehouse
506 N. St. Patrick St.
New Orleans, LA 70119
(between Bienville St. and Orleans Ave., near City Park Ave.)

HOURS: Monday--Thursday 10AM - 3PM.

Phone: 504-483-9300
Fax: 504-486-7740

E-mail: homelesswarehouse@unitygno.org

Program staff may request available items through this form, e-mail or in-person.

Recently housed clients may make accompanied visits to the warehouse to select and pick-up available items.

Furniture and household goods are provided on an as available basis.

Client and Requisitioner Information
1) Client Name
Please enter the first and last name of the head of household.
Your answer
2) Address
Client's Street Address, Unit #, City, and ZIP Code.
Your answer
3) Client's Phone Number(s)
Primary & alternate numbers whenever delivery is requested, note when number belongs to an associate.
Your answer
4) Case Worker / Housing Specialist
Name of person submitting the requisition form and, when pertinent, a UNITY affiliated worker.
Your answer
5) Agency and Program Name
Name of Agency and Program for which Requisitioner works and/or which supports client.
Your answer
6) Caseworker / Housing Specialist Office Phone Number
Your answer
7) Caseworker / Housing Specialist Cell Phone Number
Your answer
8) Caseworker / Housing Specialist E-mail Address
Your answer
Client Data and Eligibility
9) Program List
Please indicate what program is PAYING for clients' housing and/or case management services
10) Household Furnishings
Is the client's apartment already furnished?
11) Income
Does client have any income?
Required
12) Veteran Status
Has the client (or any member of their household) ever been a member of any branch of the Armed Forces?
13) Number in Household
How many people are currently inhabiting this home?
14) Recent, Literal Homeless
In the past 3 months, has the client slept primarily on the street, in a shelter, in a vehicle, or in an abandoned building?
Starter Kit / Household Supplies / Furniture Request
PLEASE MARK OR LIST ALL REQUESTED ITEMS
15) Starter Kit (Kitchen Supplies, Bed & Bath Linens, & Toiletry Sets) [one per household member]
Contents include table ware, cooking utensils and dishes; sheets, pillows and towels; toiletries and 1 or 2 house cleaning items. Kits must be picked up Monday - Thursday 10AM to 3PM.
16) Household Supplies
Please be specific. Requested Household Supplies not included in Started Kit (will be provided as available at the time of request).
Your answer
17) Requested Furniture Items
Please be specific. Items will be provided as available at the time of request. No waiting lists for items are kept.
Your answer
18) Starter Kit / Household Supplies / Furniture Pick Up Date
Starter Kits must be picked up by program staff. Please select the date (M-Th) you plan to come.
MM
/
DD
/
YYYY
19) Planned Client Visit Date
Program staff is encouraged to bring clients to select items during regular warehouse hours. Please select the date (M-Th) you plan to bring your client.
MM
/
DD
/
YYYY
20) Preferred Furniture Delivery Date
Deliveries are available for selected large furniture items and typically occur on Fridays. Deliveries are not scheduled for Tuesday, Saturday, or Sunday.
MM
/
DD
/
YYYY
When completed, please print this page for your records before selecting "Submit."
Submit
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