Bloomington SVDP Furntiure Request Form

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

Our warehouse is no longer open to the public for Saturday distribution
because of a lack of parking and other issues

WE ARE ACCEPTING REQUESTS FOR NEW FURNITURE IF YOU (furniture recipient)
CAN MEET THE FOLLOWING THREE CONDITIONS:

1. Must Be Available By Phone On Saturday Mornings between 8 AM and Noon

2. Must Allow SVDP to Select Furniture in Consultation with You by Phone

3. Must Be Able to Move Furniture From Outside to Inside Residence
After Furniture is Delieverd by SVDP
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.
The person on this form will be contacted by phone for an interview and if approved a voucher will be issued.

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