Register A Mobile Pantry

Agencies

Reporting

Register to host a mobile pantry

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:

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.

Also please be aware 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 assessed.

Cancellations

All cancellations MUST be addressed in writing a minimum of 24 hours prior to scheduled delivery.
You may do this via our contact page or Fax (810) 239-2396. Cancellations not meeting the deadline will be subject to re-stocking fees of up to $300.00.

Agency Name*
Agency Number*
County -Where distribution will occur*
Contact Person*
Contact Phone*
Email Address*
Site of Distribution Information
Site Location/Name
Site Phone
Site Address
Street Address Address Line 2 City State ZIP Code
Frozen product?*
Non-food items?*
Onsite Equipment
For loading / Unloading Do you have any of the following ? To choose multiple items hold down Ctrl when selecting items
Other Equipment--
Your delivery date and time are dependent upon availability. You will be contacted if there is a scheduling issue. Dates and times are first come/first served basis.
Requested Delivery Date
Requested Delivery Time
Vehicle Type*
Distribution Date*
Distribution Time*
Would you like a representative from the SNAP (Bridge Card) program to attend your distribution?
Post this distribution to website?*
Drop off directions or other pertinent information
I am human
Name
This field is for validation purposes and should be left unchanged.

Agencies

Reporting

Register to host a mobile pantry

Cancellations

All cancellations MUST be addressed in writing a minimum of 24 hours prior to scheduled delivery.
You may do this via our contact page or Fax (810) 239-2396. Cancellations not meeting the deadline will be subject to re-stocking fees of up to $300.00.

Site of Distribution Information

Your delivery date and time are dependent upon availability. You will be contacted if there is a scheduling issue. Dates and times are first come/first served basis.

2300 Lapeer Road, Flint MI 48503

(810) 239-4441

General Fax: (810) 239-4498

Register A Mobile Pantry

Agencies

Reporting

Register to host a mobile pantry

Cancellations

All cancellations MUST be addressed in writing a minimum of 24 hours prior to scheduled delivery. You may do this via our contact page or Fax (810) 239-2396. Cancellations not meeting the deadline will be subject to re-stocking fees of up to $300.00.

Site of Distribution Information

Your delivery date and time are dependent upon availability. You will be contacted if there is a scheduling issue. Dates and times are first come/first served basis.

All cancellations MUST be addressed in writing a minimum of 24 hours prior to scheduled delivery.
You may do this via our contact page or Fax (810) 239-2396. Cancellations not meeting the deadline will be subject to re-stocking fees of up to $300.00.