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Furniture needs assessment form

Furniture Needs Assessment form

Please note this service does not replace existing furniture and white goods for free. Customers who want to replace existing items may be charged.

e.g. homelessness, temporary accommodation
e.g. social care
(please indicate)
Please tell the names, age and relationship to you

Details of Employment

(time in employment in months / years)
Please complete the below with full details for you and your partner and specify frequency:
Please select below what income do you receive
Please provide details of the frequency of your different income and the amounts in the box below
Please select all the income your partner receives from the list below
Please give details of the amount and frequency of your partner's income

Outgoings and any current debts

(Please include: rent, utilities, car repayments, tax, insurances, credit cards, loans, catalogues, hire purchase agreements) For any outstanding debts, please confirm the company and the repayment amount. Please also include a copy of your latest bank statement.

Please select your outgoings below. In the box below, please give details of the frequency and amounts.
Please provide details of the frequency and amounts of your outgoings below
Please select your partner's outgoings below. Please give more detail of the amounts and frequency in the box below.
Please give detail of the frequency and amount your partner's income in the box below

Avenues Accessed

Have you tried any of the following avenues to source furniture? If they have been unsuccessful, please explain why

Your Furniture requirements

Please select your furniture needs from the list below
Please give details of what kind of sofa do you need (small, medium, large) and the amount of furniture you have picked from the list above

Please note that the Furniture Recycling Project cannot guarantee white goods' stock levels if a customer is in urgent need.

Declaration

I confirm that the information given on this form is accurate to the best of my knowledge.

Please type your name here, which will act as your signature.
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Page last reviewed 18/09/2020