The Philadelphia Furniture Bank is a program of Pathways to Housing PA
Client Referral Guidelines and Referral Form
Please read the Client Referral Guidelines before filling out the Referral Form.
Philadelphia Furniture Bank relies on a network of non-profit and governmental human service
agencies to screen and pre-qualify clients for our program and accompany those clients to our
warehouse to select their furniture.
REFERRAL GUIDELINES
 We only take referrals from Member Agencies. Make sure your Agency is a PFB Member Agency
or visit our website www.phillyfurniturebank.org/member-agencies for information on how to
become a Member Agency.
 Clients can receive no-cost furniture from PFB once per life crisis. Ask your client if he or she has
received furniture from PFB in the past. We’ll check our database to confirm the client’s history
with PFB. Please note: PFB furniture is owned by your client and should move with your client if
they change residences.
 Referrals for clients who have received furniture previously will be reviewed by the PFB Program
Manager to ensure that a new qualifying life crisis has occurred since the client’s last furniture
order.
 Our furniture is used and distributed by us “as is.” All upholstered furniture has been examined
and treated for insect infestation and is certified as pest-free. There are no other guarantees as
to the condition or functionality of our furniture.
 Clients must make their own arrangements to take their furniture home with them on the same
day, or prepay same day in cash, money order or agency check for curbside delivery.
MAKING AN APPOINTMENT
 Every Member Agency has a PFB Designated Contact. Only those staff members authorized by
your agency’s PFB Designated Contact List can make referrals to the PFB.
 There is a $25.00 referral fee due for each client referral. The referral fee may be paid at the
time of the appointment by cash, money order or agency check. A Member Agency can choose
to be invoiced for the referral fee(s) at the end of the month with prior approval.
 Your Agency is responsible for the $25.00 referral fee for any client who is scheduled for an
appointment at PFB. The referral fee still applies for clients who fail to keep their appointment
to select furniture or who cancel less than two business days prior to their scheduled
appointment, as well as clients who keep their appointment but opt not to select any furniture.
Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org
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You or someone at your Agency must conduct a home visit to ensure that the client is already
occupying the apartment/house where the furniture will be used and to verify the client’s
specific needs. Whoever accompanies the client to his/her appointment should be familiar with
any space or delivery restrictions in the home.
Once you have verified your client’s specific furniture needs, complete the Client Referral Form
in consultation with your client.
After you have completed the Client Referral Form, you may schedule an appointment by email
to Furniture@pathwaystohousingpa.org or by calling 215-390-1500 x 1301.
In your email or voicemail please specify the following information:
o Agency name
o Name and contact information for case manager or referring staff
o Client’s first and last name
o Address where the furniture will be used
o Preferred date and time for appointment
o Whether the client will take the furniture with them or require curbside delivery.
We will send you a reply email indicating at least two appointment dates closest to your
preferred date. You must respond to confirm the selected appointment date and time.
CANCELLATIONS / NO-SHOWS
Once you have confirmed a client appointment, your Agency will be charged a $25.00 referral fee unless
the appointment is canceled at noon at least two business days prior to the scheduled appointment
date and time. No-shows, late cancels, and clients who keep their appointment but “don’t see anything
they like” will all incur the $25.00 fee, which must be paid by the Agency before any additional client
appointments can be scheduled.
COMING IN FOR AN APPOINTMENT
 All clients must be accompanied by a case manager or other Member Agency representative.
Agency staff can keep the appointment and select furniture on the client’s behalf. However, the
client cannot come to the appointment without a representative of the referring agency.
 The client and Agency staff must bring the following items to the appointment:
o Copy of the completed Client Referral Form
o $25.00 referral fee in cash, agency check or money order payable to Pathways to
Housing PA (unless prior arrangements have been made to invoice the Member Agency
for referral fees monthly)
o Cash, agency check, or money order for $75.00 payable to Pathways to Housing PA if the
client requires curbside delivery
o A translator if needed. We currently have no bilingual staff at the Furniture Bank.
Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org
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Your clients are responsible to get the furniture home from our warehouse. Clients will not be
permitted to select furniture until/unless arrangements have been made to transport the
furniture home. Two options are available:
o OPTION 1: Client takes the furniture home from the warehouse on the same day. Your
client must come to the warehouse for his/her appointment with a van or truck, people
to help load the furniture, and all necessary packing materials, ropes, etc. to secure the
load. Our warehouse personnel can assist with loading the furniture but the client has
primary responsibility to manage the loading process. If this option is selected, the client
should park in the PPA parking lot across the street until after the furniture is selected
and moved to our loading dock. At that time, the van or truck can be moved into
position to load the furniture.
o OPTION 2: Client can pre-pay $75.00 (cash, agency check, or money order payable to
Philadelphia Furniture Bank) to utilize our curbside delivery service. Our goal is to
provide same-day or next-day delivery but this may not always be possible. Clients
and/or Agency staff are responsible to be on site to accept the delivery and move the
furniture inside the home. We do not provide in-home delivery.
Because space at the warehouse is limited, we ask that the client bring no more than one family
member/friend. If the client will be transporting the furniture him/herself, any additional
helpers who will be loading and unloading the furniture can wait in the client’s vehicle until the
appointment is completed.
Children are not allowed at the warehouse at any time for safety reasons.
Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org
Client Referral Form
CLIENT INFORMATION
Name
Street Address
Apartment #
City, State, Zip
Best Phone # to Call
Alternate Phone #
Household Size
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Include all family and non-family household members, including the Client
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AGENCY CASE MANAGER / REFERRAL STAFF CONTACT INFORMATION
Name
Office Phone #
Email
Staff accompanying
client to PFB
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Agency
Mobile Phone #
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FURNITURE ITEMS REQUESTED
The number of items provided for each client depends on family size, client need, and current availability.
Furniture
FOR OFFICE USE ONLY:
Item Description (maximum # guidelines)
Requested
Order Fulfillment
Double Bed (1 per household)
Single Bed (1 per additional person)
Kitchen/Dining Table (1 per household)
Kitchen/Dining Chairs (1 per person)
Sofa (1 per household)
Arm Chair (1 per family; 2 for families of 5 or more)
Occasional Tables (coffee, end and bedside tables)
Dresser
Bookshelf
Desk
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Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org
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Select One:
☐ Client will transport furniture on the day of the appointment
☐ Client will need curbside delivery and will bring cash or money order for $75.00 to the appointment
CLIENT BACKGROUND INFORMATION (FOR STATISTICAL PURPOSES ONLY)
Zip Code
Race
Hispanic/Latino?
Family Status
Military Service and
Veteran Status –
PRIMARY CLIENT
Military Service and
Veteran Status – OTHER
HOUSEHOLD MEMBER
Persons in Household
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☐ African American / Black
☐ Asian
☐ White
☐ Bi-racial or Multi-racial
☐ Native American
☐ Other (Specify)
☐ Yes
☐ No
☐ Single
☐ Widowed
☐ Married
☐ Separated
☐ Divorced
☐ Other (Specify)
☐ No Military Service History
☐ Current Active Military Service
☐ Current Military Reserve Status
☐ Recently Separated Veteran (discharged/released within 1 year of date)
☐ Special Disabled Veteran
☐ Vietnam Era Veteran
☐ Other Veteran
☐ No Military Service History
☐ Current Active Military Service
☐ Current Military Reserve Status
☐ Recently Separated Veteran (discharged/released within 1 year date)
☐ Special Disabled Veteran
☐ Vietnam Era Veteran
☐ Other Veteran
_Click here to enter text.___ # of Adult Males (age 18 and over)
_Click here to enter text.___ # of Adult Females (age 18 and over)
__Click here to enter text.__ # of Children and Teenagers (17 and Under)
Annual Household
Income
☐ Less than $6,000 per year
☐ $6,000 to $11,999 per year
☐ $12,000 to $17,999 per year
☐ $18,000 to $23,999 per year
☐ $24,000 to $35,999 per year
☐ $36,000 or more per year
Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org
Select and rank the top 1 or 2 reasons for needing assistance at this time. Place a 1 next to the top
reason and a 2 next to the 2nd reason
Click Death or Divorce
Click Fire or Flood
Click Physical
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Click DHS Involvement
Click Formerly Incarcerated
Click Previously Homeless
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Click Drug or Alcohol Rehab
Click Hospitalization
Click Refugee or Immigrant
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Click Domestic Violence
Click Loss of Job/Employment Click Relocation
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Click Eviction
Click Mental Health
Click Robbery Victim
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Brief description of current living situation and need for furniture:
Click here to enter text.
Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org
Client Checklist and Agreement
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My appointment at Philadelphia Furniture Bank is scheduled for
Day __Click here to enter text.__________
Time ___Click here to enter text.___________
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Philadelphia Furniture Bank is located at:
3412 J Street, Lower Level
Philadelphia, PA 19134
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I understand that my case manager or agency referral staff must accompany me to my
appointment.
I understand that I must call my case manager or agency referral staff at least two business
days prior to my scheduled appointment if I need to cancel or change my appointment.
I understand that all furniture is used and is offered in “as is” condition with no guarantees
for functionality or quality.
I understand there is an appointment fee of $25.00. I can pay cash or money order at the
appointment. My agency may pay with an agency check or by invoice through prior
arrangement.
I understand that I am responsible for transporting my furniture on the same day I select it.
Furniture cannot be held for me at the warehouse. My transportation plan is:
☐ I am bringing a truck, helpers, and packing materials with me to my appointment and will
take the furniture home with me
☐ I have brought $75.00 in cash or money order to prepay for curbside delivery.
☐ My agency is paying the delivery fee by prior arrangement with Philadelphia Furniture
Bank
I understand that I may bring one other person to my appointment. Any additional helpers
for packing and loading my furniture can wait in the vehicle we will be using to transport
the furniture.
I understand that children are not allowed in the warehouse under any circumstances.
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I have read and understand the above guidelines.
Client Signature __________________________________________________________________
Date _____________________________________________
Philadelphia Furniture Bank  3412 J Street, Lower Level  Philadelphia PA 19134
PFB is a project of Pathways to Housing PA. Visit our website at www.phillyfurniturebank.org