Food Box Request Form

Preferred Name*

First NameLast Name

Email (we will only use this to contact you if there are any concerns regarding your food box)*

example@example.com

Queer Cupboard is a pantry specifically for the Queer community. If there is not a member of the Queer community in your household, we will be happy to share alternative resources with you via email.

Is a member of your household part of the Queer community?*

YesNo

Number Of Adults In the Home*

Number Of Children In the Home

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Each pickup has a 30 minute window to maintain anonymity of our clients and the integrity of the food items in the box. At the end of the 30 minute window your box will be removed from the pickup bin and you will have to reschedule your appointment. If an emergency should arise and you are not able to pick up your box, please notify Queer Cupboard as quickly as possible at queercupboardtf@gmail.com or via facebook.

Appointment*

Allergies/Requests Including PC and Household Items (We will do our best to accommodate)

Please verify that you are human*