Fillable HIP Homeless Incentive Program (Wellington City Council New Zealand)

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HIP Homeless Incentive Program (Wellington City Council New Zealand)

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Client EID#:
Client Name:
Address:
Client Phone #:
Case Worker Name:
Case Worker Phone #:
Homeless Incentive Program
HIP
Submit to: hip@hacla.org
Phone: 213-252-1619
All eligible clients must be applicant individuals/families from one of the Housing Authority of City of Los Angeles (HACLA) homeless programs. Free delivery in the Los Angeles
area, however there is a $75.00 charge for deliveries to Antelope Valley and Lancaster that will be deducted from the $750.00 maximum order amount. Request for essential
furnishings does not guarantee eligibility. Color and product subject to change upon availability. Approximate delivery is between 2-3 weeks.
Move-in: Essential Furnishing Assistance up to $750.00 (Including Tax).
APPLIANCES
COST $
QTY
FURNITURE CONT.
COST $
QTY
KITCHEN
QTY
Microwave
60.00
Chest, 4-Drawer 24"
65.00
Bakeware Set
Vacuum, Small
40.00
Dinette 3pc Set
119.00
Cookware/Pan Set
Refrigerator, Small, 4.5 cu. ft.
200.00
Dinette 5pc Set
139.00
Dinnerware 16pc Set
Refrigerator, Rebuilt
325.00
Living Room Set (couch, end, coffee, lamp)
439.00
Flatware Set
Refrigerator, 10 cu. ft.
450.00
2-PC Sectional Set (Compact Size)
299.00
Glassware Set
Stove, New, 20" wide
390.00
Recliner
149.00
Stove, New, 30" wide
450.00
Sofa Only
300.00
LINENS
QTY
Stove, Rebuilt, 30" wide
300.00
Nightstand
49.00
Bath Towel 3pc Set
Table, Coffee Table
79.00
Bathroom Rug Set
Table, End Table
30.00
Comforter Set (Twin)
Comforter Set (Full)
Comforter Set (Queen)
Dish Cloth Set
FURNITURE
COST $
QTY
Pillow, Queen
Upholstered Bed Frame W/ Matt, Twin
249.00
Pillow, Standard
Upholstered Bed W/ Matt, Full
279.00
Shower Curtain
Upholstered Bed W/ Matt, Queen
329.00
Sub Total =
Tax (9.50%) =
Total =
HOUSING AUTHORITY OF THE CITY OF LOS ANGELES
2600 Wilshire Blvd, Los Angeles, California 90057
(213)252-2500 ⦁ www.hacla.org
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HIP Homeless Incentive Program (Wellington City Council New Zealand)

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Completed 15 October 2020

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