Item Request Form
THIS FORM IS FOR LOCAL RESIDENTS ONLY. IF YOU LIVE IN OR AROUND (flood victims accepted) BANDERA COUNTY TEXAS. NO OUT OF STATE REQUESTS!!! You can request items ONCE A MONTH but we will only fulfill what we can based on donations / funds / availability. There will be no attitudes or rude behavior tolerated. You will be blocked and unable to utilize services in the future. This is a free service provided to HELP make things EASIER for everyone not harder on us. We are not paid to do this. Everyone helping is volunteering their time.
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 confirmed with you via text. If you do not have a phone that can text, please let us know in your application.
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 MUST be filled out EVERY single MONTH to receive items. This is not an automatic monthly box. You are not automatically approved every month.
I have read the above and agree to follow the rules. I also understand that I am not entitled to these services nor will I be able to utilize them if I don’t follow the rules.
*
Yes I understand.
No I do not understand
Your Information
Full Name
*
First Name
Last Name
# of People in Household
*
# of Kids in Household / List ages
example@example.com
Phone Number
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please list items you need in order by priority (most needed to least) BE SPECIFIC. Please don’t write “whatever will work” instead “toilet paper, diapers with size, wipes, canned goods, cereal etc.” We will be building your box based around this specifically. The items we give will depend on what we have, the cost of what you’re asking for, how often you use this program / the outdoor pantries etc. We want to help you specifically with what you need versus guessing what you could use. We are trying to not give anyone anything they won’t use / don’t necessarily need. Thank you for understanding. You can apply for this once a month.
Additional Notes (Include allergies or dietary restrictions here please)
Submit
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