Retail Pick Up Form - Second Harvest Food Bank of East Central Indiana

Retail Pick Up Form

"*" indicates required fields

Agency Name*

I have a scale*

If you are weighing your own items, enter "yes," if you are counting your items, enter "no." It helps a lot with our calculations.

Retail Store Name*

Store #*

List Items Here

Please enter the number of boxes you receive of each item in the appropriate boxes. If you have multiple pick-ups from the same location, press the (+) sign to add a new entry for each different date. The total weight will be calculated automatically.

Pickup Date

Bakery

Meat

Produce

Deli

Dairy

Frozen Grocery

Dry Grocery

Non-Food

List Item Weight Here

Please enter the pounds you receive of each item in the appropriate boxes. If you have multiple pick-ups from the same location, press the (+) sign to add a new entry for each different date. The total weight will be calculated automatically.

Pickup Date

Bakery

Meat

Produce

Deli

Dairy

Frozen Grocery

Dry Grocery

Non-Food

This field is hidden when viewing the form

Bakery

This field is hidden when viewing the form

Meat

This field is hidden when viewing the form

Produce

This field is hidden when viewing the form

Deli

This field is hidden when viewing the form

Dairy

This field is hidden when viewing the form

Frozen Grocery

This field is hidden when viewing the form

Dry Grocery

This field is hidden when viewing the form

Non Food

Agency Contact Email*

CAPTCHA

Translate »