Furniture Request Form Date Name Date of Birth ID Number(last four digits only) ID Type: Health Card Driver's Licence Birth Certificate Passport Other Street Address City Postal Code Phone Number Email Items Requested: Single Mattress Double Mattress Queen Mattress Bedding Night Table Dresser Couch Love Seat Arm Chair Shelves Lamps End Table Kitchen Table Kitchen Chairs Coffee Table Pots/Pans Dishes Kitchen Utensils Other Items: I need delivery for these items. I can arrange to pick up these items. Submit Request
