Mobile Food Pantry Registration

Please complete and submit this form to request a Mobile Food Pantry delivery to your desired location.  Please understand this request does not guarantee delivery.  A Food Bank representative will contact you to confirm your information and the status of your request. In submitting this form, you are indicating that you agree to the following: I understand the cost of the Mobile Food Pantry to be delivered to the requested site is:

12 Pallets delivered less than 40 miles =$500.00
12 Pallets delivered greater than 40miles = $600.00

Product is to be distributed only to people demonstrating need.  All staff, volunteers, and clients will be made aware, no item provided by the Food Bank of Eastern Michigan is  to be sold, traded, or bartered.  I am also aware that it is the hosting agency’s responsibility to secure all equipment provided by the Food Bank of Eastern Michigan (e.g. trailer, totes and pallets, etc.) at all times. Items will be picked up at the specified date and time.  If trailer, totes, pallets are not returned in a clean manner, a $100 clean-up fee will be charged.

AGENCY NAME  
AGENCY NUMBER  
ADDRESS
CITY, ZIPCODE
TELEPHONE
CONTACT PERSON
EMAIL    
SITE LOCATION/NAME
ADDRESS
CITY ,ZIP
PHONE
DELIVERY DATE*
DELIVERY TIME*
TYPE TRUCK**
DIST. DATE
DIST. TIME
DIRECTIONS TO DROP
*Preferred  
**Over 40 miles=straight truck  
Sign-in sheets must be returned to the Food Bank within one week of delivery.  

 

 

 

HyperLink

 

For additional information contact  Maggie Wheeler; mwheeler@fbem.org

or call 810.239.4441


  Send Page To a Friend

©2009 Food Bank of Eastern Michigan
To report web errors please email the webmaster