Food Pick Up Order from Active Faith for week of 5/25/20 @ 401 Washington, South Lyon
In the interest in maintaining social distancing, when you pull up to our building, please remain in your car and one of our volunteers will meet you there. All items requested are subject to availability as the list is always changing. No confirmation will be sent.
Email address *
First and Last Name *
Your answer
Complete address including zipcode *
Your answer
Number of adults in the household (18+) *
Your answer
Number of Children in the Household (under 18) *
Your answer
Phone number (only to be used if there is a question about your order) *
Your answer
Are you a current Active Faith client? (For bookkeeping purposes only, does not affect eligibility to receive emergency food assistance) *
What day do you prefer to pick up your food? (You may come to the pantry only once per week.) *
Please choose an available time slot to pick up your food. *
Please list any food allergies/sensitivities (Food allergy considerations will be accommodated when possible)
Your answer
If you are in need of baby items, please list here. Subject to availability. We do have Pediasure Vanilla Shake so please indicate if you could use this.
Your answer
Miscellaneous Items - Choose 1 (Limited- Subject to availability) *
Are you in need of personal hygiene products? Choose 1 item:
Cleaning Supplies (Choose 1)
Paper Products (Choose 1)
Check items you wish to receive today
Canned Tomato Products (Choose 1)
Canned Soup (Choice 1)
Canned Soup (Choice 2)
Fish Products (Choose 1)
Peanut Butter or Jelly (Please choose 1)
Check items you wish to receive today.
Canned Vegetables (Choice 1) Subject to availability
Canned Vegetables (Choice 2)
Canned Vegetables (Choice 3)
Canned Beans (Choice 1)
Canned Beans (Choice 2)
Dry Beans (Choose 1)
Canned Fruit (Choice 1)
Canned Fruit (Choice 2)
Canned Meat (Choice 1)
Canned Meat (Choice 2)
Bread (Choose 1)
Check Items you wish to receive today.
Cereal- please comment what type of cereal you prefer. Subject to availability.
Your answer
Juice (Choose 1)
Perishable Items you wish to receive today.
Frozen Meat (Please choose 1) Subject to availability.
Fresh Produce (Check yes or no) You will be given a variety of what we have available. *
Please read the following disclosure statement, by submitting this form you are declaring that you are in need of emergency food or agree to the conditions listed.
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