Landfall Food Delivery Request Form

Please fill out this form to request a food delivery. This form is for Landfall residents only. Please submit your requests by Monday at 9:00 a.m. for Tuesday delivery.

Deliveries will occur every week on Tuesdays between 3:30-5:00 pm.

If you would like deliveries on a different date, please submit a request to: https://form.jotform.com/221016367878159

Contact 651-390-6507 or email info@eastmetrofooddelivery.org with questions.

Name*

First NameLast Name

Enter an Address*

Phone Number*

Format: (000) 000-0000.

Alternate Phone Number

Format: (000) 000-0000.

Email

example@example.com

Every weekEvery other weekOnce a monthOne time

How many people in your household are children (ages 0-17)?*

How many people in your household are adults (ages 18-64)?*

How many people in your household are seniors (age 65+)?*

In compliance with the state’s TEFAP program, eligibility guidelines are posted here and the data privacy statement is here.

By submitting this form, I verify that I am eligible to receive TEFAP commodity food because:
• I am in Minnesota
• My household income is 300% or less of the Federal Poverty Guidelines.
• I am also eligible if I receive or participate in the following services or programs:

MFIP (Minnesota Family Investment Program)
Child Care Assistance, GA (General Assistance)
SNAP (Supplemental Nutritional Assistance Program)
NAPS (Nutritional Assistance Program for Seniors)
WIC (Women, Infants, and Children)
Head Start
Section 8
Public Housing
Energy Assistance

Please call 651-390-6507 or email info@eastmetrofooddelivery.org with any questions.

By submitting this form, I understand that I am voluntarily providing private information about myself. I understand I am not required to provide this data but if I do not I will not be able to have essential goods delivered to me. I understand and agree my data may be shared with providers of delivery of essential goods, persons that I give written consent and as required or authorized by law.