Curbside Order Form

Online Intake & Order Form for CURBSIDE Pick-Up HOUSEHOLD SIZE 7-9 PEOPLE

Orders placed must be picked up at either the Glencoe or Hutchinson distribution site. You will choose a site below. PLEASE DESIGNATE A PICK-UP TIME with each order.
Your Name

First NameLast Name
Address

Street Address

Apartment/Unit/Lot Number

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Have you ever received food support at McLeod Emergency Food Shelf's Glencoe location, Hutchinson location, and/or Mobile Outreach Program before today's visit?
Reason for requesting food support from McLeod Emergency Food Shelf today?
This information is for statistical purposes only.
If other, please specify
PLEASE CHOOSE CURBSIDE LOCATION AND DATE CAREFULLY. CURBSIDE IS AVAILABLE 8:30AM-12:30PM MONDAY, TUESDAY, WEDNESDAY, FRIDAY, OR 3:30PM-7:30PM THURSDAY.
Select a CURBSIDE pick-up site here:
Schedule here for an appointment on MONDAY, TUESDAY, WEDNESDAY, OR FRIDAY
Including yourself, how many people currently live in your household?
Number claimed here verified with additional household member information collected below.
Name of Person Picking up Groceries

First NameLast Name

Options	Quantity
Condensed Chicken Noodle Soup
Condensed Tomato Soup
Condensed Vegetable Soup
Condensed Cream Soup
Chili
Beef Stew
Beef Skillet Helper
Tuna Skillet Helper
Macaroni & Cheese
Variety Rice Side Dish
Variety Pasta Side Dish

Online Intake & Order Form for CURBSIDE Pick-Up HOUSEHOLD SIZE 7-9 PEOPLE