Turkey Basket Delivery - November 17
Please fill out this form to set up a delivery of a Turkey and all the fixins to your home on November 17. This is for low-income families (200% of Poverty) We can only deliver one box per address. All addresses must be in Union County NC or in the Matthews and Mint Hill zip codes.
Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Mobile Phone (if none, type NA) *
Your answer
Is it ok to text you?
Other Phone
Your answer
Email Address
Your answer
Color of house
Your answer
How many Seniors (65 & over) in the home? if none enter 0. *
Your answer
How many other adults (18 - 64)? if none enter 0. *
Your answer
How many children (0-17)? if none enter 0. *
Your answer
Do you receive food stamps?
What is the total monthly income in your house? *
Your answer
May we contact you about other free services? *
I agree that the information is accurate and request delivery of a Thanksgiving Basket on Saturday November 17. *
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This form was created inside of Common Heart.