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    Client Request Form

    Love INC of Greater Merced
  • Please make sure to agree to our terms of service and note that all questions with an * must be answered or you will not be able to submit your form.

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  • Do you...


     

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  • If Yes, please fill out below. If No, leave blank move on to Rent or Mortgage amount.

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  • FURNITURE REQUESTS ONLY!

  • Income & Expense evaluation section

    Please type numbers only, this is for monthly income totals.
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  • Details about Need

  • Future Direction

  • Verification Documents

    In order to verify the information you provide we will need proof of income and proof of residence. Verifications of income inclide copies of all forms of income in the household (SSI, Wages, Disability, Grants, TANF, etc.) Verifications of residence include the front page of a Rental/Lease Agreement--this is required for furniture requests --OR a current PG&E bill. You can upload legible photos of the necessary documents below.

  • We hope you have been encouraged by getting an opportunity to share your story. As we work with you over the next few days, we want to encourage you, believing that God values you and wants to improve your life.

  • Please sign to approve this document (click and hold mouse to draw signature, or with finger on mobile)

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