MV Helps Assistance Request
Full Name (First and Last) *
Email Address *
Street Address *
Phone Number *
Best method to reach you *
Preferred language *
Preferred Grocery Store *
Required
I would like to have groceries delivered... *
Preferred method of payment *
Required
Is there anything else you need assistance with? (ie. picking up prescriptions, delivering mail, etc.)
Questions/Comments
I agree be contacted by MV Helps to receive a match and/or be contacted by my match directly. I consent my contact information to be given to the volunteer. MV Helps will try their hardest to find a match, even though it is not guaranteed. I will not hold MV Helps responsible for any potential risks associated with the volunteer. *
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