Please make a Furniture Referral using the form below.

Note: In order for people to access the Furniture Recycling Project a customer MUST be referred into the service by a professional, for instance a neighbourhood housing officer, social worker or housing support officer. You cannot self-refer into this project. 

Furniture Service Referral 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.

Important requirement

If you have ticked no, we will not be able to process your referral so please do not continue with the rest of the form, if you would like to discuss this further please email [email protected] or call 07929824361.

e.g. homelessness, temporary accommodation
e.g. social care

Details of Employment

(time in employment in months / years)
Please complete the below with full details for the customer and their partner and specify frequency:
Please select below what income the customer receives
Please provide details of the frequency of the customers different income and the amounts in the box below
Please select all the income their partner receives from the list below
Please give details of the amount and frequency of their 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 the customers outgoings below. In the box below, please give details of the frequency and amounts.
Please provide details of the frequency and amounts of the customers outgoings below
Please select their 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 of the their partner's income in the box below

Avenues Accessed

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

All customers will be triaged to consider the best option for their furniture needs. Please encourage customers to only request limited items and encourage self help, in particular white goods are in high demand and there is a considerable waiting list

Please select the customers furniture needs from the list below
Please give details of what kind of sofa the customer needs (small, medium, large) and the amount of furniture the customer has 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.

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

Declaration

Please type your name here, which will act as your signature.

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