(Website) Free Food  Preference Form
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Full Name (First and Last) *
Phone Number *
Email Address *
What is your gender? *
What is your birthday? *
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County and Zip Code *
Number of people in your household *
How many children do you have? *
Required
How old are your child/children?
Delivery Address? *
Pick-up (Local) Location *
Delivery or Pick-up Frequency? *
What do you eat? *
Do you or your family have food allergies or other diet restrictions? If yes, please explain. *
Are you a juicer? please explain your needs.
What breakfast beverages do you want/need? *
Required
Do you need snacks between meals?
Do you enjoy spicy/hot foods? *
What is the phrase that best represents your feelings about being in the kitchen? *
How do you feel about meat? *
Required
How do you feel about fresh vegetables? *
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How do you feel about fresh fruit? *
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How do you feel about dairy? *
Required
How do you feel about dry foods (cereal, oatmeal, chips, nacho chips, syrup, pancake mix, rice)? *
Required
How do you feel about kids foods (cereal, oatmeal, lunchables)? *
Required
Does income influence the choice of food you buy? *
Sometimes, we get a bunch of delicious desserts or breads, or pastas from restaurants, how do you feel about a mystery box delivered to your door, FOOD saving you on grocery shopping? Like a Sam's or Costco quantities. *
Required
What are you good at? Skills/talents *
Would you be interested in weekly updates of Asset Organizations Process and what we're doing? *
How did you hear about us? Holiday Boxes? Facebook? Friend plus name... *
Would you like to volunteer your skills in helping build the community? *
What's today's date? *
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Thank you! We will be in touch soon!
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