EmailMe Form - Rachel's Table General Food Donation Form

Is this part of the Food Bank partnership?

Yes

No

Do not use this form for Western Mass Food Bank Donations.

Please use the dedicated Food Bank Partnership form to enter food donations for this program.

Date *

MM / DD / YYYY

Is the Restaurant/Supermarket/Other Food Donor a regular Rachel's Table Food Donor? *

Yes

No

Store/Restaurant/Other Food Donor Name *

Big Y Location

Delaney Market Location

Farmer's Market Location

KFC Location

McDonald's Location

Panera Bread Location

Pizza Hut/Taco Bell Location

Pride Location

Starbucks Location

Stop & Shop Location

Tandem Bagels Location

Food Donor Contact Name

First Last

Food Donor

Address Line 1

Address Line 2

City

State

Zip Code

Phone

### - ### - ####

Fax

### - ### - ####

Email

Donation Description

Please list items to be donated, including quantity of each item, and number of pounds.

Donation Type (Select all that apply)

Bread and Bakery

Yes

No

Dairy and Eggs

Yes

No

Prepared Foods

Yes

No

Non-perishables

Yes

No

Produce

Yes

No

Meat and Protein

Yes

No

Donation Description (please provide a brief description of the donation)

Weight Equivalencies

Heavy produce box = @50 lbs.
Light produce, bread, baked goods = @15 lbs.
Bag of bread, baked goods = @3 to 5 lbs.
Other boxes (not labelled) = @25 to 30 lbs.

Pounds *

Special Instructions

Donor Valuation (Only fill in if food donor asks for receipt)

$ Dollars

Is the donation perishable?

Yes

No

Is the meat frozen solid at pick up?

Yes

No

Is the meat frozen solid at delivery?

Yes

No

Dairy-Temperature at pickup.

Dairy-Temperature at delivery.

Is pick up location the same as donor address?

Yes

No

Address for Pick Up (If different from above.)

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Email receipt to (Only fill in if food donor provides an email address)

To be completed by driver or dispatcher

Delivered to *

Delivered to Other:

If delivered to more than one location, describe:

Source of Donation

Other Source

Dispatcher

Driver *

Other Notes (anything you think Rachel's Table should know about this donation)

Web Site