Agency Update Contact Information Form
Thank you for keeping us updated with your changes. We love to be in the know and in touch with our agency partners. If you have any questions, please contact Alexis Fick at 610-926-5802 ext. 208 or afick@helpingharvest.org
Contact Information:
*
Agency Name
Agency Reference Number
Please select the date you are completing this form:
*
-
Month
-
Day
Year
What information would you like to update?
*
Address
Hours
Phone Number
Email Address
Staff/Volunteer- Add or Remove
Agency Roles
Other
Please complete the section that corresponds with the answer you provide above.
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have a mailing address that is different from the address you just entered?
Yes
No
If yes, please state the mailing address.
Physical Address
City/Zip code
Hours (Days of Operation):
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
If you selected an answer for the question above, please state any changes in time or frequency. (Please be specific)
Phone Number:
Name of Contact
New Phone Number
If there is another phone number you would like to update, please complete this section.
Name of Contact
New Phone Number
Email Address:
Name of Contact
New Email Address
Would this contact like to recieve the Agency Newsletter?
If there is another email address you would like to update, please complete this section.
Name of Contact
New Email Address
Staff & Volunteer (Adding/Removing)
Full Name
Adding or Removing?
Staff & Volunteer (Adding/Removing)
Full Name
Adding or Removing?
Agency Roles: (Please select the one you wish to update)
Bill To (who Helping Harvest sends invoices to)
Ship To (who receives the order at your organization)
Authorized (additional contacts who can contact Helping Harvest on behalf of yourorganization)
POL Order (contact who will receive online ordering information )
Administrator (individual that oversees the organization)
Please state the individual's full name, email address, and phone number.
Any additional information:
Submit
Should be Empty: