Christmas Gift Appeal - Customer Registration Form
Please complete this form in order to request Christmas gifts
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
How did you hear about us?
*
Please Select
Newspaper
Internet
Referral from services
Other
Have you used our services before? (Christmas Gift Appeal or Clothing Bank)
*
Please provide the details for the gifts that you require: (Age, Gender, Preferences)
(EXAMPLE REQUEST - Girl - Age - 10 - Likes makeup and dolls, doesn't like puzzles)
Any other information that you feel we should know:
How will you receive the gifts? (please read and choose carefully)
I would like to select the gifts myself from the gift room and require an appointment at the Glossop branch (appointment link will be sent)
I would like to collect my gifts from the Buxton branch (appointment link will be sent)
I don't not have transport and would like delivery please (deliveries will not be until w/c 8th December)
Other
I confirm that I am NOT receiving gifts from any other group or charity. I also confirm that I will use these gifts for my own personal use. I confirm that I will not re-gift or sell any items received from The Hummingbird Project
By signing this form you agree to the statements above. Failure to do so will result in being banned from The Hummingbird Project
Continue
Continue
Should be Empty: