EmailMe Form - Rachel's Table Food Bank Route Form, Updated 11-23

Is this part of the Food Bank Partnership?

Yes

No

Date *

MM / DD / YYYY

Is the Food Donor a Regular Rachel's Table food donor? *

Yes

No

Food Donor Name *

Aldi's Location

Big Y Location

Stop & Shop Location

Cumberland Farms Location

Other Location

Donation Type (select all that apply) *

Donation Description

Weight Equivalencies

Heavy produce box = @50 lbs.
Light produce, bread, baked goods = @15 lbs.
Bag of bread, baked goods = @3 to 5 lbs.
Other boxes (not labelled) = @25 to 30 lbs.

Pounds: Bread & baked goods

Pounds: Dry Goods (includes room-temperature beverages)

Pounds: Produce (whole, room-temperature)

Pounds: Non-food items

Pounds: Dairy (includes ice cream/frozen dairy)

Pounds: Assorted Refrigerated food (includes pre-cut produce)

Pounds: Frozen Meat

Pounds: Assorted Frozen food

Is the Produce refrigerated at pickup?

Yes

No

Produce temperature at pickup.

Produce temperature at delivery.

Is the Dairy frozen?

Yes

No

Is the frozen Dairy frozen solid at pick up?

Yes

No

Is the frozen Dairy frozen solid at delivery?

Yes

No

Dairy-Temperature at pickup.

Dairy-Temperature at delivery.

Assorted Refrigerated Food-Temperature at pick up.

Assorted Refrigerated Food-Temperature at delivery.

Is the Meat frozen solid at pick up?

Yes

No

Is the Meat frozen solid at delivery?

Yes

No

Is the Assorted Frozen food frozen solid at pick up?

Yes

No

Is the Assorted Frozen food frozen solid at delivery?

Yes

No

Donor Valuation (Optional)

$ Dollars

Email receipt to

Delivered to *

Other Agency Name

Was the donation delivered to more than one Agency?

Yes

No

If delivered to more than one Agency, list Agencies:

Dispatcher

Driver *

Was the donation delivered by the Van/Box Truck? *

Yes

No

Other Notes

Su	Mo	Tu	We	Th	Fr	Sa
						1
2	3	4	5	6	7	8
9	10	11	12	13	14	15
16	17	18	19	20	21	22
23	24	25	26	27	28	29
30	31