BITMO Community Fund

Please use the form below to apply for any help that your household needs.

Name *

First

Last

First line of your address *

How many adults live in your home? *

18 and over if not in full-time education

How many children live in your home? *

Phone number *

If you are applying on someone else’s behalf, please give your name, contact information, and state your connection with that person:

Please use this space to tell us more. What will the money pay for? *

Goods supplied through the Community Fund do not come with insurance. You are strongly advised to have home contents insurance. It will be your responsibility to complete the warranty/guarantee information enclosed at delvery *

I have read and understood the above section

I understand that BITMO will not normally support repeat applications *

This is my first application
I have made an application before

Your Declaration *

I will provide accurate information about my income and spending, with evidence where possible. I understand that BITMO may need to visit me at home.
I understand that BITMO has no ongoing responsibility for the items after delivery

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