Bloomington SVDP Furntiure Request Form

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:

Must Be Available By Phone
Allow SVDP to Select Furniture For You
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.
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