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: http://www.bit.ly/foodshelfdeliverymn

Contact foodshelfdeliverymn@gmail.com or 651-390-6507 with questions.

Name*

First Name Last Name

Enter an Address*

Phone Number*

Alternate Phone Number

Email

example@example.com

How often would you like a delivery? Please note: your order must be received by 9 a.m. the Monday before the delivery.*

Every weekEvery other weekOnce a monthOne time

Are there any special requests?

*We may not always be able to fulfill these requests

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+)?*

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.