Cornwall food & supply request
Please complete the form below to request the items you will need for one-week, to feed your household. While we may not be able to source all the requested items, we will try our best. Please let us know of any allergies.

Your privacy is important to us. We will limit data access to a select group of staff. If you are uncomfortable providing you name, please email cornwallsocialservices@gmail.com or call 860-671-9315 for assistance.
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Name
Phone / email
Delivery or pick-up (if delivery, provide address below)
Delivery address
Number of adults
Number of children
What (if any) allergies are present in the household
If yes, please provide explicit details on the severity and which foods can and cannot be brought into your home.  
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