Food Pantry Disbursement Form

Please use the below form to request a food box from the Pantry. This form is for individuals and households who have already registered with the Food Pantry in the past and have received food assistance before. If you have not registered with the pantry or received assistance before, please use this form to sign-up with the Pantry, or call one of the numbers listed here to speak with a volunteer.

Please note that all food requests are subject to availability, and that the Pantry may not have all items in stock. Our volunteers may make substitutions or alterations to your order if items are out of stock. In addition, there may be some limitations on items to ensure that there is enough for everyone. We appreciate your understanding. If you have specific questions, do not hesitate to contact one of our volunteers.

If you do not have a phone number or can not be reached by phone, please provide an alternative means of contacting you so that our volunteers can reach out regarding your food assistance.
Please note any relevant dietary needs including food allergies, diabetes, food restrictions or other information our volunteers may need to know when preparing your food box.