Rhinelander Area Food Pantry Food Box Order Form March 20th

Rhinelander Area Food Pantry

Food Box Order Form for Week of March 20th
** Please note, we do our best to keep this order form up to date. Food items on the order list are subject to change and may not be available at the time your food box is packed. **
To use the pantry you must reside in Oneida County, meet income eligibility, and show valid photo ID at each visit.

For registration you will need the following documentation:

Valid Picture ID for Applicant

Proof of Physical Mailing Address (no PO Boxes) for all adults (copy of current lease, current utility bill, or first class mail with name & address)

Names and Birthdates for everyone living in the household.
Verification for children in household (birth certificate, insurance card, school report card, immunization record)

Monthly Gross Income (self reported)
Have you been to the Rhinelander Area Food Pantry before?*

YesNo, I am a new customer. Please be prepared to complete registration in person upon pick up. Bring the required documentation.
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Have there been any changes to your household? For example, number of people, telephone number, address. *
How many people are in your household? *
Please note! Your order must be placed 48 hours in advance of your pick up day.
- Orders to be picked up on Monday must be placed by midnight on Saturday.
- Orders to be picked up on Wednesday must be placed by midnight on Monday.
- Orders to be picked up on Saturday must be placed by midnight on Thursday.
When will you pick up your order? *Reminder: you can visit the Pantry once every 14 days.*

Saturday March 25th, 2023 9:00 am-11:00 am
Will a proxy be picking up for you? If so, who?
Would you like Raisins?

YesNo
Would you like Canned Fruit? *Households with 1-3 members choose up to 2 cans; 4 or more members choose up to 3 cans.

Sliced PeachesPearsMixed FruitNone
Would you like Peanut Butter?

CreamyCrunchyNone
Would you like Jelly?

GrapeStrawberryNone
Would you like Granola?

YesNo
Would you like Syrup?

YesNo
Would you like a Oatmeal?

RegularCinnamonNone
Would you like Nuts?

AlmondsWalnutsNone
Would you like Cold Cereal? *Households with 7 or more members receive 2 boxes.

TasteeosCrisp RiceCorn FlakesNone
Would you like Canned Vegetables? *Households with 1-3 members choose up to 3 cans; 4 or more members choose up to 4 cans.

CornCarrotsGreen BeansMixed VegetablesPeasDiced TomatoesNone
Would you like a package of seasoned Rice and Beans?

YesNo
Would you like Pasta Sauce?

YesNo
Would you like Pasta?

YesNo
Would you like Rice?

BrownWhiteNone
Would you like Dry Beans?

Pinto BeansBlack BeansRed BeansNone
Would you like Macaroni and Cheese? *Households with 1-3 members receive 1 box, 4 or more members receive 2 boxes.

YesNo
Would you like Soup? *Households with 1-3 members choose up to 2 cans; 4-6 members choose up to 3 cans; 7 or more members choose up to 4 cans.

Cream Of ChickenChicken NoodleVegetarian VegetableTomatoCream of MushroomNone
Would you like Canned Beans? *Households with 1-3 members choose up to 2 cans; 4 or more members choose up to 3 cans.

Kidney BeansVegetarian BeansChili BeansBlack BeansRefried BeansPork N BeansNone
Would you like Beef Gravy?

YesNo
Would you like Instant Potatoes?

YesNo
Would you like Stuffing Mix?

YesNo
Would you like a can of Tuna?

YesNo
Would you like Canned Chicken?

YesNo
Would you like Apple Cider Vinegar?

YesNo
Would you like Cornbread Mix, Flour, or Sugar?

FlourSugarCornbread MixPepperNone
Would you like Ramen?

YesNo
Would you like assorted Soda?

RegularDietNone
Would you like Assorted Snacks & Bakery Sweets? *Items may include chips, donuts, muffins, cakes, granola bars, & cookies based upon availability.

SnacksBakery SweetsBothNone
Would you like a 4 pack of LED Lightbulbs?

YesNo
Would you like a Water Saving Kit?

YesNo
Would you like a loaf of Sliced Bread? Choices are based upon availability. *If your choice is unavailable we will substitute.

WhiteWhole WheatMultigrainNone
Would you like Assorted Bakery? Bread (unsliced), rolls, and buns.

Bread onlyAssorted Buns & Rolls onlyBothNone
Would you like a variety bag of Fruits and Vegetables?

YesNo
Would you like Eggs?

YesNo
Would you like Assorted Dairy items? *Items may include yogurt, dips, cottage cheese, pudding, & cheese based upon availability.

YesNo
Would you like Frozen Vegetables if available ?

YesNo
Would you like Frozen Meat?

BeefPorkChickenFishNone
Would you like Frozen Rotisserie Chicken, Pizza, or Assorted Deli items/meals if available?

Rotisserie ChickenAssorted deli items/mealsPizzaNone
Would like Milk? Choices are subject to availability. *If your choice is unavailable we will substitute.

1%2%SkimWholeNone
Would you like Dog food, Cat food, or treats?

Dog foodDog treatsCat FoodNone
Comments?
*Please park in designated online order pick up spots and let the volunteers know that you have placed an online order.
Signature

Clear
Should be Empty:

Rhinelander Area Food Pantry

*Please park in designated online order pick up spots and let the volunteers know that you have placed an online order.