Rootstock Northwest Produce Delivery

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Please fill out this form. Note: We accept only one application per household/address.

If you prefer to fill out an offline form, please use this: document and email to apps@rootstocknw.org or mail to:

Rootstock Northwest

We will never use this information for anything other than verifying your eligibility and produce bag delivery. Only officers of Rootstock Northwest will have access to this information.

Name *

Address (for delivery). Please do not fill out this form if you already have an application or delivery to this address. *

Phone number (for delivery purposes) *

Email (for delivery notifications) *

I am looking to receive a local farm produce bag:

1x per week

1x per 2 weeks

1x per month

Number of Household Members (this will help inform the size of the grocery bags): *

Do any of the following apply? Please check as many as apply. We will only use this information to prioritize the wait list.

Yes, I am a Shoreline Farmers Market recipient

Yes, I am a relative of the Seattle Indian Health Board

Yes, I am a WIC recipient

What is your household's annual income? Everyone is welcome to apply for a bag, but, as we have limited funding, we will use this to prioritize our wait list for those the most in need.

Below $20,000

Between $20,000-$50,000

Between $50,000-$100,000

Above $100,000

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