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Food Pantry Pick Up Order Form
You MUST reside in Bandera County, Texas
Please fill out the ENTIRE application and WAIT TO BE NOTIFIED.
Filling out this application DOES NOT GUARANTEE that you will receive a box.
Due to high demand, unfortunately, we do have to screen through and either approve or deny applications.
This is a service that is provided FOR FREE to you. Please do not take advantage or be disrespectful/ rude throughout the process. *We reserve the right to refuse service*
Pickup will be a Wednesday or Thursday either the 3rd or 4th week of the month (we will set up an appointment with you via text. If you do not have a phone that can text, please let us know)
If you do not show up for your pickup, we will move on to the next person. Boxes will no longer be held. We have had produce spoil due to people not showing for multiple appointments back to back.
A NEW application has to be filled out EVERY single MONTH within the first 2 weeks of the month starting on the 1st.
Name
*
First Name
Last Name
Email
example@example.com
Phone Number
*
Please enter a valid phone number that can receive texts.
Your Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many TOTAL people in your home are you applying for food assistance for?
*
Including you as well
Number of Children in Home (age between 0-18)
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
Number of Adults in Home (age between 19-59)
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
Number of Seniors in Home (age more than 60)
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
Does anyone in the home have any doctor diagnosed allergies?
*
Please be specific
How did you hear about us? Any specifics you’d like us to know?
*
Be specific
List the top 5-10 items you could really use. We will use this to help build your box. If you have kids… what are their favorite food items? Self care items?
*
Please verify that you are human.
Submit
Should be Empty: