Appliance Ministry Application Form

Do you need an appliance?

We provide used and reconditioned single-unit washers, dryers, refrigerators, and electric ranges. All of these units are delivered to provide a temporary solution to the need. To follow our mission to build relationships and serve effectively, we partner primarily through local churches and community collaborators to fulfill requests.

Please complete the following application.

Applications will be considered based on availability and need. Those who have not received service in the past will be considered first. Once we receive your application, we will contact you by phone if there is a match with our availability to serve you.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Request

YYYY

Are you a member of a local church?

If so, which church?

Briefly describe your request and efforts to obtain a replacement unit on you own.

Please provide the following information:

Do you currently have an appliance that is not working and needs to be picked up?

Is the location on the ground floor?

Are there any obstructions or limitations to accessing the appliance?

If you answered "Yes" to the previous question, please describe the obstructions or limitations.

Appliance Ministry Application Form

Do you need an appliance?

Please complete the following application.

Thank you!