Request for Partner Agency COVID-19 Food Assistance
This form is for Partner Agencies requesting food distributions responding to COVID-19 needs ONLY. Completing this form helps expedite the request.
Partner Agency Name
*
Partner Agency Number
*
Partner Agency Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Name
*
First Name
Last Name
Contact Phone Number
*
-
Area Code
Phone Number
Contact E-mail Address
*
example@example.com
Contact Name at Distribution Location (If different from yours).
First Name
Last Name
Contact Phone Number at Distribution Location (if different from yours).
-
Area Code
Phone Number
Are you able to pick-up from Feeding South Florida?
*
Yes, at FSF HQ
Yes, at FPBC
No, please deliver (4 pallet minimum)
Requested Date of Pick-Up / Delivery
*
Available Time Frame for Pick-Up / Delivery:
*
Early Morning (7 am to 9 am)
Mid Morning (10 am to 12 pm)
Afternoon (1 pm to 3 pm)
Available any time
Number of Individuals Needing Assistance
*
Please let us know the type of product requested (check all that apply):
*
Water
MREs
Snacks
Prepared meals
Perishable items
Dry items
Would your Agency be interested in becoming a Community HUB:
*
Yes
No
Do you have volunteers to support your distribution?
*
Yes
No
If yes, how many volunteers will you have available?
Is your Agency working with the Red Cross, United Way or other organization to fulfill this request?
*
Yes
No
Is your Agency working with an Elected Official?
*
Yes, if so who?
No
Elected Official
First Name
Last Name
Is there anything else Feeding South Florida should know?
A Feeding South Florida Team Member will contact you when your request has been processed, and will finalize your Pick - Up / Delivery schedule with you.
Submit
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