2025 Christmas Grocery Gift Card Request Form

2025 Christmas Grocery Gift Card Request Form

One $50 grocery shop card per address (apartments and multifamily units must have different apartment numbers).
⁂ Christmas grocery gift cards will be given out on Saturday, December 20, 2025 ONLY, no exceptions. The location and time will be sent to you within three to five business days, to the email you provide. However, in order to be eligible, we need to receive your request by 11:59 PM, Wednesday, December 17, 2025. Please make sure to bring your valid Federal or State issued Photo ID at your time of pick-up.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are You A Member Of The Bridge Believer's Centre?*

YesNo
If you are not a member, please state how you heard about this offer:
Do you receive governmental assistance (i.e. SNAP, WIC, housing assistance, etc.)

Yes (proof may be required)No
What is your annual household gross income? (Including all who are employed)*
How many people are in your household? (Including yourself)*
If you are unable to pick up, what is the full name and phone number of your authorized pick up person, MUST have a valid Government issued ID at time of pick up (If none, write N/A in the form)?
NAME*
Authorized pick-up person
Phone Number*
Authorized person's phone number
Should be Empty: