Your submission will be reviewed within two business days.

Please note that we are closed during Jewish holidays, including Rosh Hashana, Yom Kippur, Sukkot, and Simchat Tora, as well as Passover.

Your personal details

Prefix:

selectMr.Mrs.MissMs

First Name:*

Last Name:*

Donor Type*

Home

Business

Company Name:*

Business Phone*

Home Phone*

Mobile Phone

E-mail:*

Pickup Address Details

Street Address:*

City:*

Postal Code:*

Type of Location*

Select valueApartment with elevatorApartment with no elevatorBasement apartmentWarehouseGarageRetirement HomeStorageDetached HouseTownhouseOffice BuildingGround Floor

How you heard about us

Community/Word of mouth

Website

Past donor

FD sign/truck/ad

Other

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Items you wish to donate

Furniture Category

[jrcc_furniture_categories:category]Bedroom FurnitureHome Office FurnitureDining and Kitchen FurnitureLiving Room FurnitureAllOutdoor Furniture

Furniture Item

Select Item[jrcc_furniture_items:displayName]Dining & Kitchen: Dining ChairDining & Kitchen: Dining TableDining & Kitchen: Kitchen ChairDining & Kitchen: Kitchen TableDining & Kitchen: Buffet and HutchDining & Kitchen: CabinetDining & Kitchen: Bar Stool / stoolOutdoor Furniture: Patio ChairOutdoor Furniture: Patio TableBedroom: Queen MattressBedroom: Queen BoxspringBedroom: Queen Bed FrameBedroom: Single MattressBedroom: Single BoxspringBedroom: Single Bed FrameBedroom: Double MattressBedroom: Double BoxspringBedroom: Double Bed FrameBedroom: Foot BoardBedroom: Head BoardBedroom: RailsBedroom: Night TableBedroom: Dresser/Chest of DrawersBedroom: MirrorBedroom: Dresser with mirrorBedroom: Armoire/WardrobeLiving Room: SofaLiving Room: LoveseatLiving Room: Occasional ChairLiving Room: Armchair/ recliner/ lazy boyLiving Room: Coffee TableLiving Room: Side TableLiving Room: End TableLiving Room: Wall UnitLiving Room: Television StandLiving Room: Entertainment UnitLiving Room: Sideboard/CredenzaLiving Room: PictureLiving Room: Table LampLiving Room: Floor LampLiving Room: Carpet - LargeLiving Room: Carpet - SmallLiving Room: futonLiving Room: SofabedLiving Room: Upholstered ChairLiving Room: Sectional SofaHome Office: Desk-largeHome Office: Desk-smallHome Office: Office Chair/Computer ChairHome Office: Book Shelf-LargeHome Office: Book Shelf-Small

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Review of information and confirmation

Prefix:
First Name:
Last Name:
Company Name:
Home Phone:
Business Phone:
Mobile Phone:
Email:
Street Address:
City:
Postal Code:
Type of Location:
How you heard about us

Furniture Item	Quantity

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