Furniture Assistance Application Form


Referral only in order to receive service. 

Please note: In order for our staff to respond to your application in a timely manner, be sure to answer the questions on this application precisely as possible. Remember to upload a legible proof of income and photo identification, so it doesn’t delay the process. Answer all the questions asked. If any question does not apply to you, answer “none,” “not applicable,” or “unknown.” You must provide detailed information and answer the questions as completely as possible. 

After reviewing your application, our staff will contact you to schedule an inspection. 

    • Street Address