| *Your Name |
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| Address |
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| City |
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| State |
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| Zip Code |
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| Phone Number |
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| Best time to contact you |
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| *Your E-mail Address |
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| Are you age 18 or older? |
yes |
no |
| Occupation |
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| Company you work for |
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| Habitat Resale Store (check all that interest you) |
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| Donated Goods Pick-up Service |
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| Sales Clerk |
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| Sorting |
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| Repairs |
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| Available Days |
Tues.
Wed.
Thur.
Fri.
Sat. |
| Available Times |
8-10am
10-12 noon
12-2 pm
2-4 pm
8am - 5pm |
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| How did you discover Habitat for Humanity |
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| Friends/Relatives |
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| Prior Experience |
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| Newspaper article / advertisement |
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| Radio story / advertisement |
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| Billboard |
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| Flyer / Church bulletin |
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| Store Customer |
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| Walk-in |
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| Newsletter / Donor Letter |
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| Television story / advertisement |
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| Other (please describe) |
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| Questions / Comments |
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