Rhinelander Area Food Pantry Food Box Order Form

Rhinelander Area Food Pantry

Food Box Order Form WEEK OF September 9th, 2024
* ATTENTION *

*** To use the pantry you must reside in Oneida County Wisconsin, meet income eligibility, and show valid photo ID at each visit. ***

If you have not completed registration or recertification for the 2024 year you will need:
1. Proof of Identification for Applicant and all adults in the household; this includes valid picture ID or Driver License
2. Physical Address – NO PO Boxes
3. Names and birthdates of everyone living in the household.
4. Proof of existence for each child in the household; this includes birth certificate, Wisconsin Immunization Record, school report card, court records, or state insurance.
5. Proof of Residency in Oneida Co, WI of each household adult; this includes current utility bill, or first class mail dated within the last 30 days, or current year lease.
6. Monthly Gross Income must be at or below the 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.
You will complete your registration during your visit.

If you have any questions, or if you need assistance, contact RAFP at 715-369-7237 Monday through Friday 8 am to noon.
Have you been to the Rhinelander Area Food Pantry before?*

YesNo, I am a new customer. Please list all household members below and be prepared to complete in person registration at your visit. Bring the required documentation to your pick up.
New Customers Only:
Please list all household members full names and date of birth below, only list your household members, do not duplicate info into each box:
1. First Name   Last Name   Date of Birth
2.First Name   Last Name   Date of Birth
3.First Name   Last Name   Date of Birth
4.First Name   Last Name   Date of Birth
5.First Name   Last Name   Date of Birth
6.First Name   Last Name   Date of Birth
7.First Name   Last Name   Date of Birth
8.First Name   Last Name   Date of Birth
9.First Name   Last Name   Date of Birth
10.First Name   Last Name   Date of Birth
11.First Name   Last Name   Date of Birth
12.First Name   Last Name   Date of Birth
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
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 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? *Reminder: you can visit the Pantry once every 14 days.*

Monday September 9th, 2024 - 3 pm to 5 pmWednesday September 11th, 2024 - 4 pm to 6 pmSaturday September 14th,2024 - 9am to 11:00am
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 canned fruit?

Mixed fruitPearsNone
Would you like dried fruit?

YesNo
Would you like oatmeal ?

YesNo
Would you like Canned Beans?

YesNo
Would you like dried legumes ( peas, lentils, etc )?

YesNo
Would you like Canned Vegetables?

Mixed VegetablesGreen BeansCornDiced TomatoesCarrotsPeasAllNone
Would you like soup?

YesNo
Would you like Jelly or Peanut Butter?

Peanut ButterJellyBothNone
Would you like pasta sauce?

YesNo
Would you like a miscellaneous food item?

YesNo
Would you like canned meat?

YesNo
Would you like Rice?

YesNo
Would you like instant potatoes?

YesNo
Would you like the following?

MustardSauerkrautMatcha protein drink mixNone
Would you like the following ?

Shelf stable milkShelf stable creamerFlourNone
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? * Choices are based upon availability each day and may not be available at the time your order is picked. *

FishChickenPorkBeefNone
Would you like Pizza?

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.