ReStore Donation Pick Up Form

ReStore Donation Form

*Required fields

Scheduling

Our drivers pick up donations Tues-Fri., 9am-3pm. Once we receive your donation form, we will contact you to schedule a date and time for pick up.

First name *

Last name *

Company name (if applicable)

E-mail * (We will send you a confirmation email.)

Best phone number to reach you: *

Address: *

City: *

Zip code:

Major cross streets of your location:

 

Donations(s)

Type(s) of Donation(s)

Electronics - Working	Plumbing - Working
Furniture - Good condition	Windows - Double pane only
Cabinets - Good condition	Carpet - New only
Doors - No holes	Tile - No vinyl
Appliances - Working; under 10 yrs. old

Please list all items not described in list above:

Special Requests:

Any Special instructions for pickup:

 

How did you hear about donating items?

Friend	Store Flyer
Homeowner/Volunteer/Employee	Walmart Flyer/Ad
Repeat Customer	TV ads
Habitat Central AZ	Radio ads
Habitat web site	Truck banner
Newspaper	Other
Mailer