Veteran Service Request Form

Welcome, Veterans, Active Duty, Reservists, and Families. If you're in need of furnishings, we're here to assist you. Please complete and submit the form below to request what you require.

Upon submission, you will receive an email to schedule an appointment. Remember to check your spam folder if you don't receive a response within 48 business hours.

If you have any questions or concerns, send us an email at veteran@patriotsandpaws.org.

Fields marked with * are required.

Personal Information

* First and Last Name

* Gender

* Age

* Marital Status

Married
Single
It's Complicated
Widowed/Widower

Children Under the Age of 18:

* Number of Male Children

* Number of Female Children

* Ethnicity

Asian
African American
Caucasian
Native American
Pacific Islander
Middle Eastern
Prefer not to say

Other

* Employment Status

Employed
Unemployed
Currently Looking
Retired
In School
Unable to work

* Income Level

$12,500 and under
$12,501 - $25,000
$25,001 - $50,000
$50,001 and over

* Size of Home

House
Apartment
Studio
1 Bedroom
2 Bedroom
3 Bedroom
4 Bedroom
4+ Bedroom

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