Furniture Assistance Scheme The Furniture Assistance Scheme provides basic items of furniture for people on low income who are in a crisis or emergency need due to recent changes in circumstances. To qualify for assistance you will need to complete an application form and provide evidence that you are in receipt of State Benefit. We will also require brief details of your changed circumstances including, for example, information about the support you are receiving from recognised agencies such as Social Services or Worthing Homes. Evidence of receipt of State Benefit on its own is sufficient for an application to be approved. An application form is available from Guild Care reception Methold House, North Street, Worthing, during office hours (9.00am – 5.00pm Monday – Friday) or see form below. As soon as we receive your completed application form and the information set out we will do our best to provide you with the assistance you need. We will contact you by telephone to arrange delivery of your furniture so please include a contact telephone number where messages can be taken on the application form. Ken Young Project Manager 07713641737 Furniture Assistance Scheme Application This form can be filled in on your computer or by hand Name of client Address for delivery Date (e.g. dd/mm/yyyy) Client contact number Referring Agency Name of Officer Furniture required Quantity of furniture required Single bed £15.00 0 Double bed £30.00 0 Wardrobe £15.00 0 Chest of drawers £10.00 0 Table £15.00 0 Chairs £3.00 each 0 SPECIAL DISCOUNT Other furniture is available to buy at a discount of 25% off the marked price (on purchases over £15) from The GreenHouse, Meadow Road, East Worthing BN11 2SA Tel: 01903 205302. Evidence is required of state benefits. Payment is due on delivery Benefits allowed: Disability Living Allowance / Personal Independence Payment Attendance allowance Pension Credit Carer’s Allowance Open Monday – Saturday 9.30 – 4.30 On completion, please save and email this document as an attachment to ken.young@guildcare.org or return to Guild Care Furniture Scheme Manager c/o Guild Care reception, Methold House, North Street, WORTHING, BN11 1DU. Tel: 01903 528600, Fax: 01903 528611 For office use only Delivery date Completed Goods received by: June 2014 Yes/No