Houseparts Form

All information is secure and is never sold or used for any other purpose beyond keeping you up-to-date on Raise the Roof news and information.
Your Name*

First NameLast Name
E-mail
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
I would like to give the gift of a:

Front porch - $1,000Front door - $500Kitchen cabinets - $300Interior door - $150Window - $125Floor tile - $75Bath fixture - $50Door knob - $25
Choose one of the following:

Send gift card to me and I will mailSend gift card on my behalf to recipient below
Recipient's Name

First NameLast Name
Recipient's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
I would like to make a second gift: *

Front porch - $1,000Front door - $500Kitchen cabinets - $300Interior door - $150Window - $125Floor tile - $75Bath fixture - $50Door knob - $25
Choose one of the following:*

Send gift card to me and I will mailSend gift card on my behalf to recipient below
Recipient's Name

First NameLast Name
Recipient's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Thank you for purchasing Raise the Roof House Parts and choosing gifts that will help to build a family’s home.

To order and pay for your gifts online: Please click on the button below to submit your requests. You will be taken to a page where you can pay for the total of the house parts you are purchasing.

To make your gift requests by mail: Please click on the "Print Form" button below to print your completed form. Mail with a check payable to: Habitat for Humanity Greater New Haven, 37 Union Street, New Haven, CT 06511 Please write ‘Raise the Roof House Parts’ in the memo line.
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