Tempur-Pedic Mattress Donation Application

January 14, 2015

Dear Applicant,

The United Breast Cancer Foundation (UBCF) is pleased to offer you the opportunity to receive a free Tempur-Pedic mattress, the most highly recommended bed in America. We are providing the community with 100 twin mattresses and 20 full size mattresses. Please complete the below form to be considered for this donation.  You may also download the UBCF Tempur-Pedic Mattress Application and waiver.

Full Name:




Zip code:


E-mail address:

Phone Number:

Do you or a family member have breast cancer? _____

Are you or a family member in remission from breast cancer? _____

Total number in household: ____

Total number of children under the age of 18 in household: ____

Total household income (salary, wages, social security, unemployment, alimony, child support, etc.): __________

What size mattress are you requesting? _______________

How did you learn about this opportunity?


Please share with us why are applying for this donation:


Check here to acknowledge that you can pick-up your mattress on the date of delivery. ____




Team United Breast Cancer Foundation

United Breast Cancer Foundation

205 Depot Road, Huntington Station, NY 11746

1-877-822-4287 www.ubcf.info fax 1-877-822-4287

About UBCF

UBCF is committed to offering breast health and wellness services focused on cancer prevention, screening, treatment and overall wellness. UBCF’s mission is to make a positive difference in the lives of those affected by breast cancer and carries it out through seven life-supporting patient and family programs available to women, men and families nationwide. UBCF never denies services to anyone regardless of age, race, gender, ethnicity, income or medical insurance coverage. Tax-deductible contributions may be made towards UBCF’s programs. UBCF accepts vehicle and property donations as well. Combined Federal Campaign #77934

Join Our Cause

Want to be a part of the amazing work we do? Whether you want to volunteer, fundraise, participate in events, or more, there are always ways to get involved in our mission. View our upcoming events, partnership opportunities, donation options, and more on our Get Involved page!

Host an Event

Interested in hosting an event on behalf of UBCF? We're always looking for volunteers to host a Pink Bag Event®, Tempur-Pedic® Mattress Event, or another kind of fundraising or community event. Fill out and submit our "Host an Event" form to learn more!