Buffalo Mutual Aid "Request Support" Form
This request form is for individuals who live in the Greater Buffalo-Niagara Falls area. If you live outside of this area, please email buffalomutualaid@gmail.com and we'll be happy to help find a mutual aid network in your area.

HELP YOUR NEIGHBORS.
We consist of entirely volunteers working in solidarity to aid those in need.
Are you able to give an hour or two in the interest of helping the children and families that live in our communities?
http://bit.ly/BMANVolunteer

Make a request for groceries, cleaning supplies, baby supplies, hygiene products, or any unique request you may need by filling out this form.

*Each order will receive $50 worth of groceries, with roughly an extra $25 per person in your household*
**At this time, we are limited to providing grocery/ grocery store item assistance through our Peer to Peer team**

Requests will be filled by volunteers in the order that they are received, this process may take up to five days or longer. If you have a time sensitive food need we recommend that you contact one of your local food pantries, which can be found on the map at https://bit.ly/Buffalo_FoodBanks

For a complete list of resources from the Buffalo Mutual Aid Network,
visit https://bit.ly/BMANresources

For direct financial assistance please complete this form:
https://bit.ly/BMANSolidarityfund
Would you like someone from BMAN to contact you about connecting with other resources, such as applying for food stamps, health insurance, housing services, legal services, etc.?
Clear selection
What is your name? *
What is your phone number? *
What is your email address?
What is the delivery address (including city)? *
Which neighborhood best describes where you live?
Clear selection
How many people are in your household? *
What kind of support do you need? *
Required
Do you have any dietary restrictions, allergies, or intolerances?
Clear selection
Please list other food assistance programs you are already connected with.
If asking for food, what groceries do you need?
Please be as specific as possible: 2% Milk, Chicken, White Bread, etc.
If asking for cleaning supplies, what supplies do you need?
Please be as specific as possible: Laundry Detergent, Dish Soap, etc
If asking for baby supplies, what supplies do you need?
Please be as specific as possible: Size 4T Diapers, Wipes, etc.
If asking for hygiene supplies, what supplies do you need?
Please be as specific as possible: Pads, Shampoo, Toothpaste, etc
Do you have any other needs or requests?
Any additional specifications, comments, questions, or drop off instructions?
Are you filling this form out for someone else?
If 'yes' please clarify any additional contact info above.
Clear selection
How did you find out about the Buffalo Mutual Aid Network?
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