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Assistance Form

For assistance please feel out the form below.
www.HoustonHelpingHands.com

What items do you need help with? *

Clothing

Furniture

Food

Personal Information

First Name *

Last Name *

Address 1 *

Social Security *

City *

State *

Postal Code *

Daytime Phone *

Cell Phone

Email Address *

Why you need assistance?

Why do you need help?
What are you trying to do to fix it? *

Name of people in your household and ages? *

Income household receives? *