Rhinelander Area Food Pantry Food Box Order Form

Rhinelander Area Food Pantry

Food Box Order Form Week of December 30th, 2024
Rhinelander Area Food Pantry is a community pantry.

You must meet the income eligibility guidelines below to shop at RAFP.

Monthly Gross Income must be at or below the TEFAP Income Guidelines below: this is the gross income of the entire household; this includes all wages, social security, disability, pensions, child support and federal programs like W2.

If you have any questions contact RAFP at 715-369-7237 Monday through Friday 8 am to noon.
Have you shopped at Rhinelander Area Food Pantry in the last 6 months?*

YesNo
Have there been any changes to your household? For example, number of people, telephone number, address. *
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
People in Your Household
How many people are in your household?   Number*
RAFP offers additional services.
The following questions are optional and will help to determine eligibility for the CFSP Senior Stock Box Program and other services. Your answers will also help RAFP to collect confidential data for grant writing and funding.
Please list all household members names and ages: Names and ages of all household members*
Please note! Your order must be placed in advance of your pick up day.
- Orders to be picked up on Monday must be placed by midnight on Sunday.
- Orders to be picked up on Wednesday must be placed by midnight on Tuesday.
- Orders to be picked up on Saturday must be placed by midnight on Thursday.
When will you pick up your order?*

Saturday January 4th, 2025 - 9 am to 11 am
Will a proxy be picking up for you? If so, who?
** 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. **
Would you like a variety of fresh Fruits and Vegetables?

YesNo
Would you like cold cereal?

YesNo
Would you like pancake mix or syrup?

Pancake MixSyrupBothNone
Would you like raisins?

YesNo
Would you like juice?

YesNo
Would you like canned fruit?

PearsApple SaucePlumsNone
Would you like Pasta Sauce?

YesNo
Would you like Pasta?

YesNo
Would you like Canned Beans?

PintoGarbanzoKidneyBlackAllNone
Would you like Canned Vegetables?

Collard GreensPotatoesCornGreen BeansDiced TomatoesAllNone
Would you like canned meat?

YesNo
Would you like dried beans or peas?

BeansPeasNone
Would you like Rice?

Jasmine RiceRiceBothNone
Would you like a meal kit?

YesNo
Would you like soup?

1 can2 cansNone
Would you like instant potatoes?

YesNo
Would you like any of the following food items?

SalsaNone
Would you like milk, peanut butter, jelly, kraut, or mustard?

Shelf stable milkPeanut ButterJellySauerkrautMustardNone
Would you like snacks, beverages, and sweets? ( if available )

YesNo
Would you like dog food or cat food? ( if available )

Dog foodCat foodNone
Would you like Assorted Bread, rolls, and buns?

Bread onlyAssorted Buns & Rolls onlyBothNone
Would you like Eggs if available?

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

YesNo
Would you like Milk? ( if available )

YesNo
Would you like Frozen Meat? CHOOSE ONLY 2 * Choices are based upon availability each day and may not be available at the time your order is picked. REMINDER: CHOOSE ONLY 2*

FishPorkBeefChickenNone
Would you like Pizza?

YesNo
Would you like frozen vegetables or fruit? ( if available )

YesNo
*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.