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VETERAN APPLICATION FOR FURNITURE DONATION - Active
All veterans requesting services from HHF are required to complete this form and upload their military ID. Upon receipt of a completed application, a staff member will call to arrange an appointment to meet the veteran at one of our distribution centers: either 10 Delaware Dr. Suite 1 Salem NH or 198 Lafayette Rd N. Hampton NH. The centers are open by appointment only. Veterans must provide their own truck and ample helpers to move items. Our staff is unable to assist with moving heavy items. You will be denied assistance if these requirements are not met. We may also limit the number of items donated.
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
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Montana
Nebraska
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North Carolina
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Northern Mariana Islands
Ohio
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Texas
Utah
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
*
Email
*
# Of Family Members In Your Home
Have We Served You in the Past?
Yes
No
Agency Referred
Counselor Name and Phone Number
Other Referral & Phone Number
Other Referral & Phone Number
Branch of Military
US Army
Navy
Air Force
USMC
Coast Guard
Other
Branch
# Of Years Served
Combat:
Yes
No
If Yes, Where?
Do you have any service -connected disabilities and, if so, what percent?
Items Needed
Other Referral & Phone Number
Military ID or proof of service
Drop files here or
Select files
Accepted file types: pdf, doc, doc, jpg, jpg, png, Max. file size: 30 MB, Max. files: 4.
Veteran Photo Release
*
I authorize HHF staff to use the photo taken today on Facebook or for other promotional purposes.
Yes
No
Veteran Acknowledgement
*
Veteran acknowledges that all items donated are “as is” and that Homeland Heroes Foundation is not liable for any damages or injuries that may occur as a result of these donations. I also agree to indemnify and hold harmless Homeland Heroes Foundation and any staff, Board Members or affiliates, against any and all claims, suits or actions of any kind whatsoever, for liability, damages, compensation or otherwise brought by me or by anyone on my behalf.
Yes
No
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.
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Thank you !
Your Name
(Required)
Full Name
Email
(Required)
Phone
Your Address
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Donation Amount
(Required)
$50
$100
$250
Other
Your Donation
Total
Credit Card
(Required)
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
Security Code
Cardholder Name
Menu
Home
About Us
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Events
Donate
Donate Now
Furniture Donation
Donors & Sponsors
Memorialize A Loved One
Become A Sponsor
Join Our Team
Veterans
Apply Non-Furniture
Apply For Furniture
Other Veteran Resources
Heroes Welcome Home
Memorialize A Loved One
HHF Memorial Wall Of Honor
Contact Us
+1-206-156 2849
info@harity.com
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