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Free Food Box Application- Project Maracuya
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Email *
Year of Birth *
Phone *
How Many people are in your household? *
Are you enrolled in SNAP, WIC, Medicaid or other assistance?  *
Required
Zip
What is your approximate monthly household income?  *
City
Name *
Street Address Including APT # *
Can you pick up from a Farmers Market ? *
Free Food Boxes are valued at $40 of fresh produce weekly. Can you contribute some SNAP funds to cover costs of produce?  *
Required
If you can contribute via SNAP, we will need your SNAP card number, and we will follow up with you later before any charges are run to confirm the amount. Please enter your card number so we have it on file already.  *
Gender or Sex *
How Many dependent children are in your household? *
Can we text this number?  *
Required
A copy of your responses will be emailed to the address you provided.
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