Shopper Intake Form
Welcome to House of Plenty Free Store, under SolBloomCo. Every item in this space is completely free, and this short intake form simply helps us understand community needs so we can keep the store stocked, supportive, and growing.This form is simple, private, and judgement-free.There is no ID required, no proof of income, and no eligibility requirements of any kind. If you are here, we trust that you are seeking support and you are always welcome.The information you share helps us to: Understand what items and resources are most needed, track the impact we’re making in the community, Improve our services and store offerings & Connect you with other SolBloomCo programs if you ever choose. All information is kept confidential and used only to support you. We are here to provide clothing, essentials, household items, and access to upcoming wellness and community programs designed to assist individuals and families through times of transition or need.Thank you for trusting us. We’re honored to walk alongside you. 🌼
Full Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Phone Number
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Please enter a valid phone number.
Email Address
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example@example.com
Gender
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Male
Female
Non-binary
Prefer not to say
Other
How did you hear about us?
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Which of the following currently describes your current living situation?
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Transitional Housing
Homeless or Unhoused
Staying with family or friends
Recently moved to the area
Securing a new home soon
Other
Household size including yourself:
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How to Visit the House of Plenty Free Store
Thank you for completing the Shopper Intake Form. Please note that we are no longer operating by appointment. The store is open for walk-ins on Monday, Wednesday, Thursday, Saturday, and Sunday from 12:00 p.m. to 4:00 p.m. You are welcome to send a text message before visiting, but it is not required. At this time, the nonprofit is still in its beginning stages, and I am currently the primary person managing the store, handling operations, and assisting shoppers, with occasional weekend support from my partner. While I strive to be present during all listed open hours, there may be rare occasions when I need to step out briefly for childcare responsibilities or essential errands. We appreciate your patience and understanding as we continue to grow, build our volunteer team, and create a reliable community resource for all who need it
By typing your name and signing below, you give permission for SolBloomCo to use this information only for confidential record-keeping and to better support your experience at House of Plenty.
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Signature
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