Please help me

Is this form being filled out by a person other then yourself ? *

Yes No

Full name *

First

Last

If Yes please give details below *

If Yes details please *

Address *

Line 1

Line 2

City

State

Zip Code

Country

What date do you move in to your new residence ? *

Country of Birth *

Australia New Zealand other

Are you of Aboriginal or Torres Strait Islander origin? *

Yes No

If other please supply *

How many People will be living in at the new address . *

Child 1 M/F Age ? *

Child 2 M/F Age? *

Child 3 M/F Age ? *

Child 4 M/F Age? *

Are you restarting after: *

If you are escaping DV is there an AVO in place ? *

Do you have a QPS number ? *

If yes please supply *

Can you please provide a brief description of your situation: *

What Furniture do you require ? *

Restart is for people that have nothing , we are happy to supply items to people that need a particular item but WE WILL NOT be used as a upgrade service. If we get to the drop off and find the you just wanted a better one we will leave without dropping off. *

I understand I don't understand

Please ensure that the person whos name is on the form will be at the property when we deliver your items *

I understand I will be home I wont be home leave it out the back

Do You Understand that if you are approved the furniture will be second hand *

Yes No

Will there be a adult present on the delivery day to help unload ? *

Yes I can help No I can't sorry , bring help if possible

ReStart SEQ
tara@restartseq.com.au
Business Hrs : Weekdays 9am - 3pm
Location : Walloon Qld 4306
Ph : 0428758931
Copyright 2023 ABN 77 548 386 452 Privacy policy

IMPORTANT
To enable us to help you correctly,
please answer ALL the questions below.

Please note:
While we DON’T bring brand NEW furniture – we won't bring rubbish.
We supply high quality second-hand/reconditioned items.

We require the person who's name is on this form to be present when we deliver your required Items . We will not leave items
If you don’t hear back from us within 48 hours, please check your Spam/Junk folders or contact us on 0428 758 931

**** IMPORTANT ****​To enable us to help you correctly,please answer ALL the questions below.​Please note:While we DON’T bring brand NEW furniture – we won't bring rubbish.​We supply high quality second-hand/reconditioned items.

We require the person who's name is on this form to be present when we deliver your required Items . We will not leave items If you don’t hear back from us within 48 hours, please check your Spam/Junk folders or contact us on 0428 758 931

IMPORTANT
To enable us to help you correctly,
please answer ALL the questions below.

Please note:
While we DON’T bring brand NEW furniture – we won't bring rubbish.
We supply high quality second-hand/reconditioned items.

We require the person who's name is on this form to be present when we deliver your required Items . We will not leave items
If you don’t hear back from us within 48 hours, please check your Spam/Junk folders or contact us on 0428 758 931