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VETERAN APPLICATION FOR NON-FURNITURE DONATION
All veterans requesting assistance from Homeland Heroes will be required to complete this form and upload your military ID. Your request will be processed within 1-3 business days.
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
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
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?
Specific Items Needed
Other Referral & Phone Number
Military ID or proof of service
Drop files here or
Select files
Accepted file types: pdf, doc, jpg, jpg, Max. file size: 10 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
Phone
This field is for validation purposes and should be left unchanged.
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Memorialize A Loved One
Join Our Team
Veterans
Apply Non-Furniture
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Heroes Welcome Home
Memorialize A Loved One
Contact Us
+1-206-156 2849
info@harity.com
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