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C4Hmi.org Free Food Delivery Reg. Form

We delivery free fresh food to community every the 4th Monday each month, please kindly fill out the following information to help us better planning the amount of food, also we will set up a Service Card for you to keep and present to our staff when you arrived. The information you provided is protected.
The dates for delivery in 2021 are:
April 26, May 24,
June 28, July 26,
Aug. 23, Sept. 27,
Oct. 25, Nov. 22,
Dec. 27. ,
every Monday 4pm. - 6pm.  Address: 1032 N. Crooks Rd. Clawson MI 48071
* No Contact Delivery, clear your truck and stay in you car.
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Email *
Donation from 168 Asian Mart.    
Your First Name *
Your last name *
Your Phone *
Your Driver License  # *
Address ( Street number / City / State / zip code *
Your Gender *
List other Household Members ( if applicable )
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