The Potter's Hands
Important: This request form must be completed and submitted by a Case Manager or Church Representative on behalf of the client. Please read the instructions carefully and completely before doing the application.
REFERRAL REQUIREMENTS:
To be eligible for assistance, the client must be referred to The Potter's Hands by a recognized agency or local church representative.
• The Case Manager or Church Representative is responsible for completing and submitting this form.
• Once the request is received, a Potter's Hands representative will schedule an appointment for the client to visit the warehouse.
• It is strongly recommended that the Case Manager or Church Representative accompany the client to the appointment.
ITEMS NEEDED:
Please complete the following information carefully:
• Provide a detailed list of all items requested for the client.
• Indicate whether items will be picked up or delivered.
– Pick-up within 15 days of the scheduled appointment is preferred and greatly appreciated.
– If delivery is required, include special instructions (floor number, front/side/rear entrance, gate codes, etc.).
• If requesting an appliance, specify whether it must be gas or electric.
• If requesting beds, specify the quantity and size (Twin and Full sizes only).
FREQUENCY OF ASSISTANCE:
Clients may receive assistance from The Potter's Hands once every 12 months.
While we strive to fulfill every request, inventory limitations may apply. The Potter's Hands reserves the right to prioritize requests and make determinations on a case-by-case basis.
*Although we want to complete every request, we do not have the ability to do so. Given this, The Potter's Hands maintains the right to use discretion regarding priority of requests on a case by case basis.