Bloomington SVDP Furntiure Request Form

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Email: furniture@bloomingtonsvdp.org.
Voicemail:  961-1510. ext # 3

Due to the Cororna Virus:
*Our Office and Warehouse are Closed to Public Until Further Notice
HOWEVER WE ARE ACCEPTING REQUESTS FOR NEW FURNITURE IF RECIPIENT
CAN MEET THE FOLLOWING CONDITIONS:

Deliveries Are Curb Side Only  - It Will Be Recipient's Responsibility to Move Items Inside
This is an SVDP Furniture Request Form Only.  It is NOT a Furniture Voucher. 
Recipient will contacted by phone for interview and validation of Covid 19 requirements.

FURNITURE REQUEST FORM:

First Name: Last Name:
Date of Birth (mm/dd/yy): Request Date (mm/dd/yy):
Agency Support (if any) Agency Support Person (if any):
Street Address: City:
Zip: Phone1:
Phone2: Best Time to Call:
E-Mail Address (if any): Number of Persons in Household:
Monthly Household Income: Have We Given You Items Before?:
 Furniture/Appliance Items Needed:
 
Comment/Additional Information:
Please type the word YES in the
box to the right if you are a human
   Don't forget to type YES in this box