Client Application Form

Client Application

Apply for The Free Store Services

Step 1 of 7

Welcome to the Client Application form

The Free Store provides furniture and household goods to individuals and families that are being served and supported by other agencies. We don’t provide our services to individuals that are not supported by an agency.

This form is to be filled out by an employee of the agency that is supporting the person in need of household goods. Throughout this form, the employee of the agency will be referred to as the advocate.

If your agency does not already have a relationship with The Free Store call 515-282-3733 or email info.thefreestore@gmail.com so we can explain how our processes work. Agencies working with us include county assistance programs, faith-based organizations, shelters, emergency assistance, mental health services, veteran and disability programs and immigrant/refugee services

Throughout this form, you will not be able to advance to the next page if the required information is not filled in. You will be given an error message by the entry that is not right. The error message will go away as soon as you fix the problem and click the “Next” button.

When finished a completed client form will be e-mailed to you.

Tell us about your client!

Client's Name(Required)

First Last

Maiden or other surname

Birth Date(Required)

Phone(Required)

If client phone is not available, use the advocate phone number.

Can we send text messages to the client?

Yes

Delivery Address(Required)

Street Address Address Line 2 City State ZIP Code

Has the client used The Free Store before?

Yes

When did they use the The Free Store?(Required)

Signature Page

It is important for you and your client to understand our process and rules, and agree to abide by them.

Acknowledgement of FreeStore Guidelines(Required)

Freestore Guidelines for Domestic Violence Advocates and Clients

(Approved agencies include CFI-DVS, CIAC, ACCESS, LUNA, Monsoon, Nissa)

FreeStore volunteers will move the items for Des Moines area clients into a FreeStore truck at
the warehouse and will then move the items into their new home. The client can bring their
own truck and help. Non-Des Moines area clients will need to provide their own truck and help.
The warehouse loading area is next to the JuJitsu Academy, which is at 841 11th St in Des Moines: east on Crocker from Keo Way, then south on 11 th Street. We are the second building in the block.
It is the responsibility of the agency’s representative to assure that the client treats the volunteers with respect. We reserve the right to refuse to serve any family who does not treat the FreeStore volunteer (the Greeter) with respect.
We serve all qualified clients and do not discriminate on the basis of race, color, ethnicity, sex, sexual orientation or physical or mental disability.
We may limit the number of times per month an agency may send us clients.
We limit our services to advocates/agencies/ churches that have ongoing relationships with the
families they want to sponsor. We reserve the right to refuse service to any person, advocate, or agency we feel does not meet the intent of our requirements.
Normally, only the advocate and the client are allowed to go “shopping” with the Greeter. Other
helpers are to remain in the front of the warehouse except when moving/loading furniture. We will only give items to a family who already has a house, condo, duplex, apartment, etc. We DO NOT give items that will be moved into a temporary place until the family has found housing.
With few exceptions, clients are only allowed to use the FreeStore once. If a second trip is allowed it cannot be within 5 years of the first service or through an exception made by the advocate with the FreeStore.
Finally, the Greeter is a volunteer and is at the warehouse to serve the advocate and client by appointment. The client must notify the advocate or Greeter in advance if the appointment cannot be met. If a client cancels twice, her/his request may not be served.

I have read and understand The FreeStore Guidelines.

How will household goods be transferred from The Free Store warehouse to the client's home?(Required)

The Free Store will transport household goods to the client’s home in the DM metro.

The client and advocate will provide their own transportation for household goods.

Is the client going to come to the warehouse to select their items?

Yes

How will client get to the warehouse?(Required)

How will client get home from the warehouse?(Required)

Type your initials in boxes below to signify you understand that The Free Store is an independent non-profit, run entirely by volunteers and that you will treat volunteers ( greeters, loaders, and drivers ) with respect and understand that the volunteer serving you has final say on any conflicts or decisions.

Client Initials(Required)

Advocate Initials(Required)

Questions, Comments, Concerns

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Fee only

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Advocate Notification Message

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Scheduler Notification Message

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guidelines

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SchedulerEmail

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