Donation Request Form

Thank you for thinking of us! Please fill out the form below regarding your donation and a staff member will contact you to schedule a pick-up time. If you have any issues submitting your request, please email Kent@llhfh.org directly.

Items must be located in a garage or protected curbside to qualify for pickup. Under no circumstances can a Habitat employee or volunteer enter a home.

Your Name(s) (required)

Address (required)

Zipcode (required)

Phone(required)

Email(required)

Have you traveled outside of the United States in the past 30 days?
yesno

If yes, have you traveled to China, Japan, Italy, Iran, or South Korea?
yesnono international travel

Have you had contact with a person with COVID-19?
yesno

Have you had fever, shaking, chills, and/or sweats?
yesno

Do you have any cough or other cold symptoms or shortness of breath?
yesno

Please attach photo(s) of the items you wish to donate.

Please describe the item(s) you'd like to donate