CSFP (PAN) Door Dash Delivery Enrollment
By signing this Proxy Authorization Form, I authorize any Door Dash driver to serve as my Proxy for the retrieval of my monthly senior food box (CSFP) during my participation in the Door Dash delivery services. I understand that in accordance to the Texas Department of Agriculture (TDA) guidelines, I must check-in with the CSFP (PAN) team once a year to ensure that no information has changed since my last certification and will authorize them to recertify me back into the senior box program CSFP (PAN).
*
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does your phone accept text messages?
*
Yes
No
PAN ID
*
Issued to you when you initially enrolled. Don’t know your PAN ID? Contact the team at csfpteam@ntfb.org or call us at (214) 367-3123 and we can resend this information to you.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Special Instructions for Delivery
Submit
Should be Empty: