Food Box Delivery Request Form

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Food Boxes will be delivered by a Volunteer on Tuesdays or Fridays between 9am-1pm, depending on where you live in the county. A new form must be submitted with each request. A MATCH team member will contact you to follow up on your request and provide additional assistance as needed. For questions contact 828.659.5289

First and Last Name Required *

Contact Number *

Delivery Address *

City and Zip Code *

Number in Household *

The Food Box Delivery program was created for community members whose transportation barriers prevent them from attending a food distribution in community. Do you have reliable transportation? *

Yes

If you have reliable transportation, please visit the Community Resource Guide to learn more about food distributions near you!

What other types of support would you like to learn more about? *

Access to Health Care-Medicaid/Medicare/ Health Insurance

Medication Assistance

Mental Health Resources

Substance Use Disorder/Recovery Resources

Emergency Assistance

Vision/Dental Resources

Harm Reduction/ Hep C info

NONE

Other:

Required

Type of Health Care Coverage *

Medicaid

Medicare

Private Insurance

Uninsured

Required

Are you submitting this form on someone else's behalf? *

Yes

If yes, please provide your name and phone number so that we can confirm the delivery. *

Is your house number clearly displayed? *

Yes

If not, please provide landmarks or other instructions to ensure delivery. *

Submit

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