Agencies - Second Harvest

This page contains all the forms and resources that you might need if you’re running an agency affiliated with Second Harvest. If you have any questions about any of the forms on this page or navigating Agency Express, please contact Sunni Matters at smatters@curehunger.org or at 765.287.8698 ext. 116

ORDERING

writing

Real Time Order Form - Agency Express

AGENCY REPORTS

Retail Pick-Up Report

Returns and Credits

Food Safety Training Quiz

Change of Information Form

Agency(Required)

Person Completing this Form(Required)

First Last

Agency Name

County Served

Please fill out ONLY the information being changed

Agency Name:

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address is the Same

Yes

No

Mailing Address

Street Address Address Line 2 City ZIP / Postal Code

Agency Director

or CEO, Pastor, or other Main Leader's Name

First Last

Agency Contact

Whoever is serving as Agency Liason

First Last

Public Phone

For neighbors in need to contact you

Contact Telephone

For direct contact with Agency Liaison

Agency Email

Agency Website

Agency Fax

Hours of Operation

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Authorized Shoppers

Description of Program

Additional Information

Is it okay to publish the agency's name, address, telephone number, and hours of operation?(Required)

Yes

No

Food Safety Training

TEFAP REPORTS

Quarterly Inventory Report

Eligibility Certificate

Pantry Proxy Form

Aggregate Eligibility Certificate

Written Notice Form for TEFAP Beneficiaries

Discrimination Complaint Form

RESOURCES

FDA Recall List

Meat & Poultry Color Guide

Temperature Log

Temperature Log - Multiple units

Pest Control Form for Non-Professional In-House