ACP Food Pantry Intake and Pickup Scheduling

Who are you requesting food pickup for?

Is this your first time registering with ACP Food Pantry?

Group pickup requests require ACP confirmation. ACP will review your request and contact you with an approved pickup date and time.

Organization or group name

Organization type

Primary contact name

First NameLast Name

Phone number

Please enter a valid phone number.Format: (000) 000-0000.

Email address

example@example.com

Number of households represented

Total number of people being served

Number of children ages 0 to 17

Number of adults age 60 or older

Name of person picking up the food

Location where the food will be redistributed

Dietary, allergy, cultural, or special food considerations

Requested distribution date

Date

Additional comments

I confirm that the information provided represents the group or households for whom I am requesting food and that the food will be distributed to those households.

Head of Household Full Name

First NameLast Name

Street Address

City

ZIP Code

County of Residence

County name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Preferred Contact Method

Total Number of People in Household

Number of Children Ages 0 to 17

Number of Seniors Age 60 and Older

Dietary Needs and Food Preferences

Additional Dietary Details

ACP will make reasonable efforts to accommodate dietary preferences and food restrictions based on available inventory. Specific foods cannot be guaranteed.

Pickup and No-Show Policy ACP prepares food in advance based on your scheduled pickup time. Please arrive during your selected 15-minute pickup window. ACP will hold your prepared food for up to 15 minutes after your scheduled pickup time. After the 15-minute grace period, ACP is not required to continue holding your food, and the food may be made available to another household. If you are unable to attend your scheduled pickup, please cancel or reschedule before your appointment time whenever possible. Households that miss 3 scheduled pickup appointments without completing the pickup will no longer be eligible to participate in the ACP pantry appointment program unless ACP approves reinstatement. I understand that ACP prepares food based on my scheduled pickup time. I agree to arrive during my selected pickup window. ACP will hold my prepared food for up to 15 minutes after my scheduled pickup time. After that time, ACP is not required to hold my food. I also understand that if I miss 3 scheduled pickup appointments, I may no longer be eligible to participate in the ACP Food Pantry program unless ACP approves reinstatement.

Initials

Please enter your initials to acknowledge the policy.

The last day to register for October pick up is Oct 12th at 6:00pm

Grand Opening Pickup Date and Time

The last day to register for Novermber pick up is Nov 16th at 6:00pm

Thanksgiving Pickup Date and Time

The last day to register for December pick up is Dec 9th at 6:00pm

Winter Holiday Pickup Date and Time

Is someone other than the Primary Contact authorized to pick up food?

Authorized Pickup Person #1

Authorized Pickup Person #2

registration for October is closed please feel free sign up for November and/or December dates.

ACP Southeastern Resource & Logistics Center Food Pantry

Group Pickup Requests

Group Pickup Information

Household Information

Food and Dietary Needs

Select Your Food Pickup Date and Time

Pick up location

Pickup Authorization