Home > Uncategorized > Tempur-Pedic Mattress Donation Application

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:

Address:

City:

State:

Zip code:

County:

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. ____

Signature:

Date:

Sincerely,

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