Test - Society of St. Vincent de Paul

Bed Voucher Referral - 2024 UPDATE

Once submitted, the completed form is sent to the Thrift Store. A confirmation email is sent to the Vincentian who submitted the form. If the customer's email address is provided in the field below, an email is sent to him/her with instructions for redeeming the voucher. An email is sent to the conference treasurer notifying that a voucher has been submitted.

Conference(Required)

Select the St. Vincent de Paul Conference from the drop down list.

Referred By(Required)

Type your name (Vincentian) into the first and last name boxes.

First Last

Vincentian Phone(Required)

Vincentian Email(Required)

Date

Type in today's date. The voucher is valid for 14 days from the day you submit the voucher.

Customer's Name(Required)

Type the name of the person needing a bed voucher into the first and last name boxes.

First Last

Address(Required)

Type in the address on the customer's photo ID. This is used to verify identity at the Thrift Store.

Street Address Address Line 2 City ZIP / Postal Code

Customer Phone

Type in the phone number of the customer needing the voucher.

Customer Email

Type in the email address of the customer needing the voucher. Notification of the submitted voucher is sent to the customer by email with instructions for redeeming the voucher.

Max Amount Conference/Organization Will Pay For All Items Combined(Required)

Enter the total maximum dollar amount that will be paid for all of the bed selections detailed below required.

Twin Bed Items

Please indicate below the quantity of each item your Conference/Organization will cover with this voucher.

Twin Complete Set ($140)