FWC Food Pantry Order Form
To make ordering easier items are grouped by section.  Please look in the description of each section to determine what items are listed in this section.  You will place the numerical quantity needed in the box UNDER the item you are ordering. Please honor and note if there is a LIMIT given for that item. If left blank we will assume that item is not needed. Some items may not be available as we are totally dependent upon the donations we receive. If several varieties of an item are listed, the total quantity of these items may be limited in order to meet the requests we receive.
     As you are ordering, please remember that a Food Pantry should be used to Supplement your grocery needs and is not a Replacement for purchasing your entire grocery needs. We try to keep this list up to date by noting when an item is not currently available.

  • Please leave an accurate telephone (cell) number so we can contact you in case your order pick up needs to move to a different time. 
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Email *
PLEASE INDICATE IF THIS IS A NEW EMAIL
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First Name *
Last Name *
Phone number *
PLEASE INDICATE IF THIS IS A NEW PHONE NUMBER
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Address (Street, Apt.) *
Address (City State and Zipcode)
 *
Number in the Family *
Children (Ages & Gender) *
Identify others living in your home and their relationship to you. *
How did you hear about us? *
 If your doctor has specifically told you to reduce your sodium or sugar intake, please check the appropriate box.   If you select either of these specialty diets, we will provide, if available, the special diet items as indicated. However, we are not able to provide the same item from our regular items and/or low sugar and/or low sodium items .  Please check the box(es) of the special diet you need.
No Salt/Lower Sodium
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Sugar Free/Lite
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Gluten Free
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Food allergies
Do you have anything you want to share with us?  You can write a comment, suggestion, concern or even if you want us to pray for you?  Please type it in this section. You can skip this section, if desired.
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