New Customer Sign-up Form

New Customer Sign-up Form

This is a form for new customers only. If you are already registered with TOPSS, you can return to our website and schedule services.
Go ahead and schedule pantry services after you fill out this form. We'll contact you if additional steps are necessary.

Please also read the information below and contact us at director@tops.org if you have any questions.

PLEASE READ CAREFULLY:
- TOPSS is a food pantry that receives food from the Shared Harvest Food Bank in Fairfield, Ohio. TOPSS has a contract with Shared Harvest to follow their government regulations regarding food safety, cleanliness, and food date guidelines. The staff at TOPSS works hard to make sure that the food you receive is safe.
- TOPSS also "rescues" food from businesses in the area. This means that food that is too old to be sold is taken to TOPSS and redistributed to those in need. This includes produce, bread, pastries, and frozen meat. According to the USDA, meat that is frozen on or before its expiration date is safe indefinitely. In these cases, we recommend keeping those meats frozen until ready to consume, then thaw and cook thoroughly. Bread, pastries, and produce are checked daily at TOPSS for spoilage or mold. If you receive food that is spoiled or moldy, please let us know right away. We can replace those items.
- All other canned and dried goods at TOPSS are typically within their expiration date but have their own set of guidelines. Most unopened pasta and cereals are good for at least two years after their expiration, however, we still try to get these items out to clients before they expire. You should never receive any dry goods or shelf-stable items from us that are more than 3 months expired. If you receive any old shelf-stable items, please bring that to our attention.
- If you do not want expired items we recommend not accepting the produce, bread, or miscellaneous items in a delivery box. If you order online, you will have the option to exclude those items from your box.
- TOPSS is meant to be a supplement to your SNAP or other benefits or groceries. This means that we are not meant to be your only food source. If you qualify, we recommend signing. up for SNAP. If you need help with that, please let us know.
- You may only receive services from TOPSS once per week.
- TOPSS serves clients who live within the Talawanda School District and fall within our income guidelines. Our income guidelines are posted on our website (TOPSS.org). We do not verify income; you will not need to provide proof of income.
- Please keep in mind that TOPSS is a FREE service and most of the people you'll come in contact with are volunteers who are donating their time. We try our best to give you the best quality food with the best service but sometimes we fall short. We encourage you to let us know if something is wrong but we also ask for your patience and grace. In an ideal world, we would be able to provide you with everything you want but we have to work within our resources. We are not a grocery store and we do not have unlimited funds to supply for every need or desire. Please know that we are always doing the best we're able.
Name*

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
Phone Number
Please enter a valid phone number.
How many people live in your household?
Please list the names and ages of the other people in your household below. If this is left blank, we'll assume you are a 1 person household.
Please type your name below as an electronic signature indicating that you have read and understood the information on this page, and that you acknowledge that the above information will be kept in our database for at least 7 years after your most recent pantry service. This information stays within the Shared Harvest System and is not shared outside of this food bank and its affiliates (local food pantries). It is held confidential and private and only viewed by staff (not volunteers) unless you receive food via delivery in which case your address and phone number are shared with the driver who has also signed a confidentiality agreement.
Type your full name as your signature
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