EmailMe Form - Rachel's Table Food Bank Route Form, Updated 1/26

Is this part of the Food Bank Partnership?

Yes

No

Date *

MM / DD / YYYY

Food Donor Name *

Aldi's Location *

Big Y Location *

C & S Wholesale Grocers Location *

Stop & Shop Location *

Cumberland Farms Location *

Unlisted Food Donor Name

Donation Type (select all that apply) *

Donation Description

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: Bread & baked goods

Pounds: Dry Goods (includes room-temperature beverages)

Pounds: Produce (whole, room-temperature)

Pounds: Non-food items

Pounds: Dairy (includes ice cream/frozen dairy)

Pounds: Assorted Refrigerated food (includes pre-cut produce)

Pounds: Frozen Meat

Pounds: Assorted Frozen food

Is the Produce refrigerated at pickup?

Yes

No

Produce temperature at pickup.

Produce temperature at delivery.

Is the Dairy frozen?

Yes

No

Is the frozen Dairy frozen solid at pick up?

Yes

No

Is the frozen Dairy frozen solid at delivery?

Yes

No

Dairy-Temperature at pickup.

Dairy-Temperature at delivery.

Assorted Refrigerated Food-Temperature at pick up.

Assorted Refrigerated Food-Temperature at delivery.

Is the Meat frozen solid at pick up?

Yes

No

Is the Meat frozen solid at delivery?

Yes

No

Is the Assorted Frozen food frozen solid at pick up?

Yes

No

Is the Assorted Frozen food frozen solid at delivery?

Yes

No

Donor Valuation (Optional)

$ Dollars

Email receipt to

Delivered to: *

Unlisted Agency Name

Was the donation delivered to more than one Agency?

Yes

No

If delivered to more than one Agency, list Agencies:

Dispatcher

Driver/Crew Members *

Vehicle donation delivered by: *

Van

Box Truck

Personal Vehicle

Other Notes