Pantry Numbers

1
Pantry Number* This field is required.This is the number you use to log into your Akron Canton Regional Foodbank account.
2
Pantry Name* This field is required.
3
Which city is your pantry located in?* This field is required.
Please Select
Please Select
Alliance
Beach City
Canal Fulton
Canton
Hartville
Louisville
Massillon
Minerva
North Canton
North Lawrence
Waynesburg
4
Reporting Month* This field is required.Please mark 01 as the day. Thank you!
Date
Month
Day
Year
5
Name of Person Reporting (First & Last)* This field is required.
First Name
Last Name
6
Phone Number* This field is required.
Area Code
Phone Number
7
Email* This field is required.
example@example.com
8
Number of households WITH children* This field is required.
9
Number of households WITHOUT children* This field is required.
10
TOTAL number of households* This field is required.
11
Number of seniors served (age 60 & older) in households WITH children* This field is required.
12
Number of seniors served (age 60 & older) in households WITHOUT children* This field is required.
13
TOTAL number of seniors served (age 60 & older)* This field is required.
14
Number of adults served (age 18-59) in households WITH children* This field is required.
15
Number of adults served (age 18-59) in households WITHOUT children* This field is required.
16
TOTAL number of adults served (age 18-59)* This field is required.
17
Number of children served (birth - 17)* This field is required.
18
TOTAL number of people served in households WITH children* This field is required.
19
TOTAL number of people served in households WITHOUT children* This field is required.
20
Update InformationIf any of your information (address, phone number, pantry point of contact) has changed since your last entry, please enter it below.
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21
Questions, comments, or concerns:
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