Text Box: ____ Pick Up   ____ Donate                                  DATE: ______________


Acct. #___________	Queens’  Closet Consignors Intake Form


Name: ___________________________________________  Phone: ____________________


Address:  _____________________________________________________________________
                                 Street                                                                     City                                            Zip

I have received and agree to the terms of the QC consignment Guidelines and the Contract:  


Signature:  ____________________________________________  Date:  ________________