Donation Form
First Name *
Last Name *
Email *
Phone: Main Contact Number *
Phone: Other Number
Pickup Address *
City (Pickup) *
State (Pickup) *
Zip Code (Pickup) *
Neighborhood *
Mailing Address
*if different than pickup address
City (Mailing)
State (Mailing)
Zip Code (Mailing)
Items must be picked up by date (optional)
*please note we cannot always acommodate short timelines
MM
/
DD
/
YYYY
Pick Up Location- Please Note there is a $20 pick-up fee upon completion of the pick up. *
Required
Seating
(indicate number of items to be donated)
Sofa
Love Seat
Sectional
Chairs
(indicate number of items to be donated)
Living Room
Recliner
Rocker
Tables
(indicate number of items to be donated)
End Table
Coffee Table
Sofa Table
Dining/Kitchen
(indicate number of items to be donated)
Dining/Kitchen Table
Chair(s)
Stools
Lamps
(indicate number of items to be donated)
Floor Lamp
Table Lamp
Bedroom Furniture
(indicate number of items to be donated)
Dresser
Dresser w/mirror
Night Stand
Shelves/Bookcases
(indicate number of items to be donated)
Small (3') | Shelves
Medium (4') | Shelves
Large (6') | Shelves
Mattress
(indicate number of items to be donated)
Queen Mattress
Full Mattress
Twin Mattress
Box Springs
(indicate number of items to be donated)
Queen Box Springs
Full Box Springs
Twin Box Springs
Bed Springs
(indicate number of items to be donated)
Queen Bed Springs
Full Bed Springs
Twin Bed Springs
Bed Frame
(indicate number of items to be donated)
Queen Bed Frame
Full Bed Frame
Twin Bed Frame
Bunk Bed Bed Frame
Misc. Items
(indicate number of items to be donated)
Kitchen Items
Counter-top Appliances
Bedding
Bath Towels
Additional Items
(indicate number of items to be donated)
Additional Items/Comments
Submit
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