Food Recipient Application: Delivery Program

Organization nAMECharitable/Not-For-Profit Registration No.Organization WebsiteOrganization Address

Address where food will be delivered.

Street AddressCityPostal Code

Unit/FLOOR/SUITE/P.O. BoxProvince

Publish address?

Publicizing your business will list it on the Second Harvest website and may feature it in communications, celebrating your engagement.

Yes, publish address

Contact INFORMATION

Your NameEmail AddressMobile PhoneBusiness Phone

Oranization Details

Organization TypeProgram Types‍Are you registered on the Second Harvest Food Rescue App?Have you ever received food from Second Harvest here through direct delivery or pick-up?
Approximate # of people who receive food from your organizationEstimate percentage of people by age group

Total should add up to 100%.

Children (0-14)

Youth (15-24)

Adults (25-64)

Seniors (65+)

Location Food restrictions?

Do you redistribute food to other organizations?

Location Equipment

# Residential fridges/freezers

# industrial fridges/freezers

# chest
fridges/freezers

# walk-in fridges/freezers

Can you store at least 200 lb of food per drop-off?

Does location have a truck for pallet pick ups?Is the truck dock-level?

Is the truck refrigerated?

‍I agree to receive electronic communications from Second Harvest regarding Food Delivery & Pick upYes

Organization INFORMATION

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