SNAP Sign up – Feed & Seed Co.

Name *

First

Last

Email *

Phone(best # for pickup reminders) *

Preferred Communication Method: (Pickup/Order Reminders) *

Want to receive text notifications? (Deadline and Pickup Reminders) *

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Home Address *

Address Line 1

Address Line 2

City

State

Zip Code

How did you hear about FoodShare?

Box Pickup Location - every other week (Select One) *

How many boxes would you like? (Paid for & picked up every other week.) *

If paying with SNAP/EBT, only 1 box can be purchased for your first and second pickups, then 2 boxes beginning third pickup. Please read FAQ on previous page for information regarding box quantity limitations.

Order Frequency *

Deadline Reminder: Orders must be placed by 5 PM on Thursday to be picked up the following week. Orders placed after this time will be deferred to next available pickup.

Payment Method *

All payments with SNAP must be done in-person. You must bring your SNAP card with you for pickup and use it for. Please also ensure there are sufficient funds available to pay for the order being picked up — and if pre-ordering, enough funds to prepay for the following order.

Additional information for the FoodShare team (optional)

Agreement *

I understand that by submitting my order I am committed to pick up the ordered produce box at the next available distribution. I also understand that I must bring my SNAP/EBT card for payment to receive the cost of $5 per box, otherwise I must have $20 cash or card to pay full price for the box.

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