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2. Dear Pantry Guest:

   Please complete this form. Orders will be filled on a first come, first served basis.  You will be contacted regarding pickup/delivery arrangements.  We will do our best to honor your requests, but may have to substitute if our supply is low.  If you do not wish any substitutions, please note this below.  As always, if you have any questions, please call us at 508-699-0100, ext. 2520.

4. Substitutions allowed?*

   1. Yes
   2. No
6. First Name*
7. Last Name*
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number

    Phone number and/or email address required

16. Email Address

    Phone number and/or email address required

18. Number of Adults in household*
    -- Select One --12345678
19. Number of Children in household*
    -- Select One --012345678
21. Food Allergies / Diet Restrictions

25. Please select two choices in each category (unless otherwise instructed) and we will do our very best to get you at least one of your picks!  If nothing is marked, we will not give you anything from that category.  Please remember, since we are a full-donation food pantry, quantities and offerings will vary depending on our supply.

27. Cereal

    1. Sugary
    2. Not Sugary
28. Cold

    1. Bars
    2. Corn
    3. Oats
    4. Rice
    5. Wheat
29. Hot

    1. Oatmeal
    2. Other
30. Pancakes

    1. Pancake Mix - Yes
    2. Pancake Mix - No
    3. Syrup - Yes
    4. Syrup - No
32. Canned Tuna

    1. In Water
    2. In Oil
33. Canned Meat

    1. Chicken
    2. Chili with Beans
    3. Chili with no Beans
    4. Fish (such as sardines, salmon, anchovies)
    5. Hash
    6. Pork
    7. Spam
34. Canned Pasta

    1. Beefaroni
    2. Beef Ravioli
    3. Cheese Ravioli
    4. SpaghettiOs
    5. Spaghetti & Meatballs
36. Chunky-style Soup

    These do NOT need liquid added

    1. Beef
    2. Beef Stew
    3. Chicken
    4. Chowder
    5. Vegetable
    6. Vegetarian (no meat at all)
37. Broth

    1. Beef
    2. Chicken
    3. Vegetable
38. Condensed Soups

    These need liquid added

    1. Beef
    2. Chicken
    3. Chowder
    4. Vegetable
    5. Vegetarian (no meat at all)
39. Cream Soups

    1. Cream of celery
    2. Cream of chicken
    3. Cream of mushroom
    4. Tomato
41. Baked Beans

    1. With Pork
    2. Vegetarian
42. Tomato Products

    1. Diced
    2. Paste
    3. Sauce
    4. Stewed
    5. Whole
43. Pasta Sauce

    1. Red Sauce with Meat
    2. Red Sauce without Meat
    3. Alfredo Sauce
    4. Other
44. Dry Pasta

    1. Egg Noodles
    2. Elbows
    3. Lasagna
    4. Spaghetti
    5. Ziti or other shapes
46. Sleeve of Crackers

    1. Yes
    2. No
47. Jello/Pudding

    1. Jello
    2. Pudding
    3. Either One
48. Adult Snacks

    When available

    1. Salty
    2. Sweet
    3. Either one
49. Child Snacks

    When available

    1. Salty
    2. Sweet
    3. Either One
51. Canned Fruit

    1. Apple Sauce
    2. Cranberry Sauce
    3. Fruit Cocktail
    4. Mandarin Oranges
    5. Peaches
    6. Pears
    7. Pineapple
    8. Raisins or other dried fruit
52. Raman Noodles

    1. Beef
    2. Chicken
    3. Other
53. Macaroni and Cheese

    1. Yes
    2. No
55. Gluten-free Foods

    What types

57. Vegetables

    We will try to give you every type you want

    1. Beets
    2. Carrots
    3. Corn
    4. Green Beans
    5. Mixed Veggies
    6. Peas
    7. Potatoes
    8. Yams or similar
58. Beans

    We will try to give you every type you want

    1. Black
    2. Cannellini
    3. Chick Peas/Garbanzo
    4. Navy
    5. Pinto
    6. Red Kidney
60. Starches

    1. Dry Beans
    2. Brown Rice
    3. White Rice
    4. Quinoa
    5. Stuffing Mix
61. Starches

    1. Hot Noodle Mix
    2. Noodle Salad Mix
    3. Hamburger Helper
    4. Rice Mix
62. Starches - Potatoes

    1. Mashed Potatoes
    2. Scalloped/Au Gratin
    3. Other Potatoes
63. Baked Goods

    1. Brownie Mix
    2. Cake Mix
    3. Cookie Mix
    4. Muffin Mix
65. Choose one item

    1. Cooking/Baking item (bread crumbs, honey, flour, sugar)
    2. Spice - select type
66. Choose one item

    1. Ketchup
    2. Mustard
67. Choose one item

    1. Mayonnaise
    2. Salad Dressing - Italian/Vinaigrette
    3. Salad Dressing - Ranch
    4. Salad Dressing - French/Russian
    5. Salad Dressing - Other
69. Spice Type
71. Choose one item

    1. Pickles
    2. Relish
    3. Olives
72. Choose one item

    1. Barbecue Sauce
    2. Manwich Sauce
    3. Gravy
73. Choose one item

    1. Taco/Chili/Fajita Mix
    2. Taco Shells
    3. Salsa
    4. Chili Peppers
75. Cold Beverages

    When available

    1. Shelf-stable Dairy Milk
    2. Soy Milk
    3. Coconut Milk
    4. Fruit Juice
    5. Iced tea/Koolaid/Lemonade
    6. Nutritional Drink
    7. Soda
    8. Sports Drink
76. Hot Beverages

    1. Tea - Black
    2. Tea - Decaf
    3. Tea - Herbal
    4. Coffee - Regular
    5. Coffee - Decaf
    6. Coffee - Instant
    7. Cocoa
78. Peanut Butter

    1. Yes
    2. No
79. Jelly - ONLY for children

    1. Yes
    2. No
83. Health and Beauty Aids

    Dependent upon our supply

    1. Bar Soap - Mild
    2. Bar Soap - Scented
    3. Deodorant
    4. Shampoo
    5. Conditioner
    6. Shaving Supplies - Razor

    1. Shaving Supplies - Razor Blades
    2. Shaving Supplies - Shaving Cream
    3. Tampons
    4. Sanitary Napkins
    5. Poise
    6. Incontinence Products - Male

    1. Incontinence Products - Female
    2. Toothpaste
    3. Toothbrush
    4. Dental Floss
    5. Mouthwash
    6. Denture Cleaner
85. Male Sizes
86. Female Sizes
88. Toilet Paper

    1. Yes
    2. No
92. Baby Diapers or Pullups?

    1. Diapers
    2. Pull-ups
    3. Both
93. Sizes Needed
94. Baby Wipes?

    1. Yes
    2. No
98. If we have it, would you like:
100. Baked Goods

     1. Cake
     2. Cupcakes
     3. Cookies
     4. Muffins
     5. Pie
     6. Any
101. Bread

     1. Wheat
     2. White
     3. Bagels
     4. Bakery Bread
     5. English Muffins
     6. Any
102. Eggs

     1. Yes
     2. No
104. Fresh/Frozen

     1. Beef
     2. Chicken/Turkey
     3. Fish
     4. Hot Dogs
     5. Pork
     6. Soup
     7. Ready-to-Cook Meal
     8. Any
105. Fresh Produce

     1. Fruit
     2. Vegetables
     3. Both
106. Milk

     1. White
     2. Chocolate
108. Wish List
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110. Email address

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