Grocery Store Partnership Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

We are looking to work with local grocery stores to provide essential items via gift cards to those in need. This way we are able to help those in need and support small and local grocery stores. Please help us grow our local partners of small and local grocery stores.

Name *

First and last name

Email *

Phone number *

Does your store have a gift card system? *

Yes

Required

If your store does not have a gift card program, will you be able to track funds for beneficiaries? How so? *

Will there be a manager onsite or a beneficiary can contact if there are any issues? Please provide name and phone number. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Social Needia.

Does this form look suspicious? Report

Forms