ASI Food Pantry After-Hours Lockers (April)

ASI Food Pantry After-Hours Lockers (March)
Name*

First NameLast Name
Student ID #*
Sac State Email*

Confirmation EmailPlease re-enter your email. If you mistype your email, you won't receive a code for pick-up.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Please select your pick-up date.*
How many household members will be consuming the food?
Please just put the household count.
Please list any dietary restrictions we should know when preparing your items.
Pick any.

Chicken Stuffing Mix
Some of our items may be past the printed expiration date but they are still good to consume. Please take a look at this FOOD PRODUCT CODING & DATING GUIDE from the Sacramento Food Bank to get an accurate date of when the item is no longer consumable.
These are ready-to-eat items. Pick any.

Canned Diced TomatoesPeanut Butter JarCanned PeachesCanned Pinto BeansVegetable OilBeef Ravioli
Health and Hygiene

Narcan Nasal Spray (2 pack)Toothpaste w/ Brush
These items need to be cooked. Pick any.

Garbanzo BeansSpaghetti PastaQuick OatsDry Pinto BeansDry Black BeansWhite Corn FlourLong Grain White RiceElbow MacLentils
Would you like any other supplies?

Sensitive Tide PodsUltra Clean Tide Pods
Would you like any COVI-19 Test Kits?

1234
Do you need your locker to be below waist height?*

YesNo
Have you created a new PantrySoft account?*

YesNot yet, but I will.
I understand that I must bring my own bag to pick up my items.

I understand
I understand that if I fail to fill out the provided cancellation form & fail to pick up within my appointment time, this will result in having to use the food pantry only in person.*

I understand
I will pick up my order within 48 hours after receiving my code from LuxerOne and notify Food Pantry staff if I have any issues.*

I agree
I will pick up my order within 48 hours after receiving my code from LuxerOne and notify Food Pantry staff if I have any issues.*
*Notice: this locker order counts as your weekly visit
Should be Empty:

ASI Food Pantry After-Hours Lockers (March)

*Notice: this locker order counts as your weekly visit