Furniture Pick Up Request Form

Thank you for thinking of donating your furniture items to WIN. In order for us to plan our pick-ups, please fill out this form and we will contact you by the next business day.

Today's Date:

Name:

Email:

Home Phone:

Cell Phone:

Work Phone:

Business Name (if applicable):

Pick up Address:

Elevator:

Yes

Are you going to be moving?:

Yes

Date of move?:

Number we can reach you on after your move:

New Address:

How did you hear about WIN?:

Please list the items you would like to donate:

Please list the items that you would like to donate as this will help us to plan the pick- up date, as well as let you know what items we are able to accept at this time.

Image Upload:

Please upload any images of your furniture that you are donating.

Image Upload:

Please upload any images of your furniture that you are donating.

Agree: *

Yes

Please be aware that we are unable to accept items that do not meet the quality standards for our programs or to re-sell in our stores to support our programs. This is due to the high cost of disposing of items that we are unable to use. It is up to the driver to determine if the items that you would like to donate meet these requirements. By submitting this form, you agree to this understanding. Thank-you!

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Furniture Pick Up Request Form

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