EmailMe Form - RT General Food Donation Form, updated 1-25

Is this part of the Food Bank partnership?

Yes

No

Do not use this form for Western Mass Food Bank Donations.

Please use the dedicated Food Bank Partnership form to enter food donations for this program.

Date *

MM / DD / YYYY

Is the Restaurant/Supermarket/Farm/ Other Food Donor a regular Rachel's Table Food Donor? *

Yes

No

Store/Restaurant/Other Food Donor Name *

Big Y Location *

Delaney Market Location *

Farmer's Market Location *

Panera Bread Location *

Pizza Hut/Taco Bell Location *

Pride Location *

Stop & Shop Location *

Tandem Bagels Location *

Food Donor Contact Name

First Last

Food Donor

Address Line 1

Address Line 2

City

State

Zip Code

Phone

### - ### - ####

Fax

### - ### - ####

Email

Source of Donation *

Rescue

Food Drives

Gleaning

Purchase (ie. ESSENtials, Kalicka Milk, Backpack Program, Snack Program, Lily's Fruit)

Purchase Program

Donation Type (select all that apply) *

Produce Type (select all that apply)

Other Produce (please enter produce variety)

Donation Description (please provide a brief description of the donation)

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 *

Donor Valuation (Only fill in if food donor asks for receipt)

$ Dollars

Is the meat frozen solid at pick up?

Yes

No

Is the meat frozen solid at delivery?

Yes

No

Dairy-Temperature at pickup.

Dairy-Temperature at delivery.

Email receipt to (Only fill in if food donor provides an email address)

Delivered to: *

Affiliate Agency Name

Unlisted Affiliate Agency Name

Community/Neighbor Group Name

Unlisted Community/Neighbor Group Name

Delivered to More than One Agency

Yes

No

If the donation was delivered to more than one Agency, please fill out a second form with the information for that Agency

If delivered to more than one Agency, list Agencies:

Dispatcher

Driver *

Delivered by Van/Box Truck *

Yes

No

Other Notes (anything you think Rachel's Table should know about this donation)