Produce, Please! Application
Fill out this form to apply to be one of our families that receives fresh produce.
Email address *
Name *
Your answer
Address *
Your answer
Mobile Phone Number *
Your answer
Home Phone Number
Your answer
Number of People in Your Household *
Your answer
Number of children in your household
0-2 years old
3-4 years old
5-7 years old
8-10 years old
11-12 years old
13-15 years old
16-18 years old
19 years or older
1st Child
2nd Child
3rd Child
4th Child
5th Child
6th Child
7th Child
8 or more
Annual Household Income *
About how much does your household spend on groceries per week? *
Your answer
About how much does your household spend on fresh produce per week? *
Your answer
Which does your household prefer?
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