Fill out the form below. One of our team members will reach out within 48hours to confirm.
Please note, if the location of the home is above the first floor and no elevator/freight elevator is present or available, our drivers have the right to decline to make the delivery if they deem it unsafe to do so, before and up to the point of arrival for the delivery.

Client Name *

First Name

Last Name

Client Email

Client Phone *

Best Contact Phone

(###)

###

####

Client Street Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

CLIENT HOUSEHOLD INFORMATION

# Adult Males *

Adult Male Ages

# Adult Females *

Female Ages

Minor Ages

# Minors *

Veteran Status

Is the Unit *

Check one

Apartment

House

Does it have:

Stairs

Elevator

How many Bedrooms?

Is there a gate code? If so please list below

REFERRAL PARTNER INFORMATION

Name of Agency / Organization *

Business Email

Business Phone

(###)

###

####

Agent Name *

First Name

Last Name

Agent Title

Agent Direct Phone *

(###)

###

####

Agent Direct Email *

Ackowledgement *

By Checking the box below you have read and agree that all the above information is correct.

I have read and agree

Agent Name for ackowledgement *

TERMS OF ASSISTANCE

Check the responsible party for paying the program support & delivery fee *

If the client is responsible, payment must be made online before delivery (mustardseedindy.org PayPal link)

Agency

Client

If the client is not at home to receive furniture on the scheduled date and time, a $150 missed delivery fee will be added to final invoice. We will call ahead of delivery and can only wait 10-15 minutes if for some reason they are not answering the call or door. A friend, relative, case manager can also be home to accept the delivery. If we have to reschedule, they will have to unfortunately wait until the other clients after them have been served. If there phone is out, please let us know asap so we can confirm a date together.

VERIFICATION

I, the agent, have verified that the client has not received furniture from TMS previously. I, the agent, performed a home visit to verify the client’s furniture needs and acknowledge that TMS will not deliver a piece of furniture if one is already present in the home, (e.g., a couch will not be left at the home if a couch is already there when the delivery drivers arrive). I, the agent, have verified that the client has a reliable phone number to be contacted through the scheduling and delivery process and I, the agent, understand that referrals are generally processed and furniture deliveries scheduled in the order in which they are received, that TMS will contact the client to set up a delivery time, and that the delivery time can take up to 2 weeks. I, the agent, acknowledge that the furniture the client will receive is in gently used condition and while TMS will make every effort to deliver the requested furniture, TMS is only capable of bringing what is in stock on the delivery date. We (client and agent) understand the furniture I receive will be gently used, picked out by TMS may not include every item requested, and/or may include substituted items (e.g., a desk instead of a table, a TV stand instead of a coffee or end table). I, the agent, acknowledge that furniture deliveries are based on household size stated in the referral (i.e. If one person is in the home, then one living room chair will be delivered because it seats one person). We strive to be good stewards of resources, reuse, repair, rebuild, recycle, upcycle materials as we can.

We do our best to provide all items requested but can only deliver what we have in the warehouse on the date of delivery. Substitutions will be made when appropriate and/or necessary. *If we deliver the ordered furniture package and the client declines the item, we will still have to charge the package price so please confirm with them, their actual needs as we often arrive and they turn down the items but we still take the time to load, deliver, and then have to return items to the warehouse before our next delivery which holds up the drivers. As a donation based nonprofit, every minute of operations count and we have to make the best use of our time. If the client or their partner/family member become aggressive, our staff will have to exit the unit and make arrangement to deliver when the case manager is on site.

SINGLE PERSON HOUSEHOLD

Click on item if YES

Loveseat/Armchair/Recliner

Coffee Table/End Table

Friend/Visitor chair needed

Desk/Small table/TV type tray with 2 chairs

TWO-PERSON HOUSEHOLD

Click on item if YES

Loveseat or 2 Armchairs

Friend/Visitor Chair

Kitchen Table with 2 chairs

Barstools

THREE or MORE PERSON HOUSEHOLD

Click on item if YES. For Kitchen table please let us know how many chairs needed.

Couch

Coffee/end table

Friend/Visitor Chair

Kitchen Table and Chairs

ALL HOUSEHOLD

Put the number requested next to the item

Lamps (1 per bedroom)

Please disregard if you have overhead lighting already installed

Dressers

Please disregard if you already have closet space available and 1 per bedroom max due to availability

Nightstands

Mattresses - TWIN

Mattresses - Full

Children or Adult

Mattresses - Adults

Queen

Box Spring

Queen

*Frames will be provided if available Headboard and Footboard not included/Case manager can pickup if requested *Futons sometimes available *Trundles and Bunks sometimes available but we do not install. *Linens provided if available and requested *Tvs, games, puzzles sometimes available.

Additional notes from Agent

Please add any further notes or details.

WAIVER

CHECK IF YES. Agent on behalf of client

I give permission for The Mustard Seed to photograph me for use on social media, the Mustard Seed website or in other promotional materials.

I am interested in providing a quote or testimony to the service provided by The Mustard Seed?

I assume all risk of loss or injury related to or caused by the household furnishings

Thank you!

CONTACT MUSTARD SEED OF CENTRAL INDIANA

10080 E 121st Street, Suite 152,
Fishers, IN, 46037
info@mustardseedindy.org
317-572-5724
Due to the volume of calls, all calls will go to voicemail. Please email or text for timely reply.

OFFICE & WAREHOUSE HOURS

Mon, Weds., Fri: 10 a.m. - 4 p.m.
Last Saturday of the Month: 9 a.m. - 12 p.m.

We receive a large volume of calls so please email or text for a timely response - we appreciate it!

Please text to make sure someone is in the office as we are in the field or at events. Please ring front office bell for drop-offs during week. We will have you meet us around back for furniture drop offs.
Follow us on Facebook to see daily needs and pop up events! Thank you for supporting Hoosiers!

Referral Form

Location Address

Email (preferred)

Phone/Text