Pay It Forward Furniture or Appliance Donations
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County of Residence
*
Please Select
Tarrant
Parker
Wise
Other
What items do you have to donate?
*
Bed / Mattress / Frame
Dining Room Table & Chairs
Stove
Washer / Dryer
Refrigerator / Freezer
Microwave
Air Conditioner
Heater
Medical Equipment (hospital bed / walker / wheel chair, etc.)
Other
Upload pic/s of your donation here:
Browse Files
Drag and drop files here
Choose a file
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Please included any additional information we may need to know about your donation here:
Demographics
**This section helps us GREATLY with Federal and community grants, allocation of funding, and organizational accountability!**
Age - How many people in each age category live in your home: (If does not apply put 0)
How many of each gender (including yourself) live in the household.
Race/Ethnicity
White (Caucasian)
Hispanic or Latino
Black or African-American
Native American or Alaskan Native
Native Hawaiian or other Pacific islander
Multiple Races or Ethnicities
Other
Employment Data:
Employed, working part time (1-31 hours per week)
Employed, working full timeĀ (32 + hours per week)
Unemployed and looking for work
Unemployed and NOT looking for work
Retired
Disabled/not able to work
Marital Status
Married
Widowed
Divorced
Seperated
Never Married
Highest Education Level Achieved
Less than high school diploma
High school diploma or GED
Some college
Associate's degree
Bachelor's degree
Graduate (Master's or PhD) degree
Household Income Range:
0-$20,000
$20,000-$30,000
$30,000-$40,000
$40,000-$50,000
$50,000-$60,000
$60,000-$70,000
$70,000-$80,000
$80,000-$90,000
$90,000-$100,000
Above $100,000
Do you attend a church?
Yes
No
No, but I would like to
If yes, what church do you attend?
Submit
Should be Empty: