Referral Form

Please return questions to referrals@mustardseedindy.org • (317) 572-5724

Timeline: TMS contacts client within 14 business days; total wait can be up to 5 weeks.
Availability: We deliver what we have in the warehouse on delivery date; substitutions may occur.
Once-in-a-lifetime: Furniture bank assistance is available once.

The Mustard Seed of Central Indiana (TMS)

Delivery Only
NO client pickups. TMS delivers to the client’s residence.
Mileage policy: No distance tier fee within Marion or Hamilton County. Outside those counties, mileage is calculated using the federal mileage rate.

TMS Use Only

Final total charged after adjustments.

Client Information

Household

Delivery Details

If the home is above the first floor and no elevator/freight elevator is present or available, drivers may decline delivery if deemed unsafe (before and up to the point of arrival).

County / Mileage

Marion/Hamilton: no distance tier fee.
Estimate uses round-trip miles (one-way × 2) × rate.

Packages or Single Items

Baby/toddler/king mattresses are NOT available. Linens provided when available.

Add-Ons / Options

Requested Items (Household-Based)

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.
Single: Armchair/Recliner
Single: Coffee Table OR End Table (preference)
Single: “Friend” Chair
Single: Desk/Card Table/TV Trays w 2 Chairs

2 Member Household

Loveseat / 2 Armchairs
Coffee Table OR End Table (preference)
“Friend” Chair (if available)
Kitchen Table w 2 Chairs

3+ Member Household

Couch
Coffee Table (Y/N) and/or End Table (Y/N)
“Friend” Chair
Kitchen Table & # Chairs

Bedroom Items

Mattress / Frames

Box springs not guaranteed pending inventory.
Baby, toddler, and/or king-sized mattresses are NOT available. Linens provided when available.

Referral Partner Information

Terms of Assistance

If client pays: cash or cashier’s check at time of delivery.
If client pays: cash or cashier’s check at time of delivery.
Missed delivery: If client is not home to receive furniture on the scheduled date/time, a $150 missed delivery fee will be added to final invoice.

Verification

Please initial the steps below to indicate agent and client understanding and agreement to comply with referral standards. Initials from both the client and agent are required for this section. Agency may obtain verbal authorization to sign/initial on client’s behalf if client agrees.

Additional Needs / Concerns / Questions

Agreement

After submit, a complete referral summary is copied to your clipboard for pasting into your internal workflow.

Estimated Charges

Auto-calc
Package
$0
Mileage
$0
Add-ons
$0
Estimated Total
$0
Missed delivery fee: $150 if client not home at scheduled time.