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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
