Veteran application for non-furniture donation

Apply for Non-Furniture Donation

Home

Veterans

Apply 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 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*
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
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
Comments
This field is for validation purposes and should be left unchanged.