All Order Forms are due no later than Friday at 12 PM
Participant Name:
Pick Up Day & Time
Pantry Name:
Pick Up Person
Order for week of:
Daytime phone
Age of Family
Members
# Cans Canned Goods
Asparagus
Carrots
Peas
Peas/Carrots
Mushrooms
Spinach
Tomatoes
Beans
Corn
Mixed Veg.
Potatoes
Tomato Sauce
Tomato Paste
Cost Total
1.69
0.84
0.84
0.84
0.84
1.09
0.95
0.84
0.84
0.84
0.84
0.79
0.59
-
# Cans Fruit
Cost Total
Pears
1.30
Mandarin Orange 1.30
Pineapple
1.49
Peaches
1.30
Applesauce
1.99
Fruit Cocktail
1.50
# Cans Beans
Kidney
Chili Beans
Pinto
Garbanzo
Great Northern
Baked Beans
Black Beans
Refried Beans
Cost Total
0.85 0.85 0.85 0.85 0.85 1.50 0.85 0.99 -
# Cans Soup/Stew
Chunky
Cream Soup
Chicken Noodle
Vegetable
Beef Stew
Chili
Cost Total
1.99
0.89
0.69
1.19
2.20
1.60
-
*Note: 2 pounds per person, per week
# lbs
*Frozen Meat
Chicken (3-5 lb)
Pork (2 lb)
Hamburger (1 lb)
Sausage (1 lb)
Lunch Meat (8 oz)
Lunch Meat (1 lb)
Hotdogs (8-10 pkg)
Cost Total
7.50
5.00
4.00
4.00
2.00
3.50
2.00
-
Male
# Pkg
Email
Female
Meal Makers
Pasta (Plain)
Spaghetti
Mac/Cheese
Rice (White)
Rice (Brown)
Chicken Helper
Tuna Helper
Hamb. Helper
Gravy
Sloppy Joe Sauce
Pasta Salad
Spaghetti Sauce
Rice Mixes
Mash Pot (Instant)
Boxed Potato
Stuffing
Taco Seasoning
Noodles (Egg)
Dried Beans (Black)
# Cans Pasta/Meat
Tuna
Chicken
Spam
Ham
Hash
Ravioli (etc.)
Cost Total
1.50
1.50
1.20
1.80
1.80
1.60
1.60
1.60
1.30
1.00
1.60
2.00
1.00
1.50
1.50
2.00
0.70
1.50
1.89
-
# Pkg
Baking Supplies
Flour
Cooking Oil
Pancake Mix
Evap. Milk
Sweet Cond. Mlk
Sugar
Shortening
Jello
Pudding
Baking Soda
# Pkg
Beverages
Cost Total
Coffee (Reg)
4.00
Coffee (Decaf)
4.00
Iced Tea
2.30
Powder Drnk. Mix 2.75
Juice
3.70
-
# Pkg
Cost Total
1.50
2.20
2.80
1.70
2.60
1.00
-
# Pkg
Snacks (3 max)
Cost Total
Crackers
2.60
Popcorn
2.00
Snack cups (fruit)
2.20
Snack cups (pudding) 2.20
-
# Pkg
Dairy Product
Eggs (dozen)
Milk (Whole)
Milk (2%)
Milk (Skim)
Cheese
Margarine
# Pkg
Cost Total
1.60
3.50
3.50
3.50
4.00
2.00
-
Cost Total
1.50
3.00
2.50
1.50
2.20
2.50
5.00
1.25
1.30
0.79
-
Condiments
Salt
Pepper
Ketchup
Mustard
Peanut Butter
Jelly/Jam
Mayo
Miracle Whip
Taco Sauce
Salsa
Pickles
Pancake Syrup
Salad Dressing
Cost Total
0.70
1.99
2.79
1.69
2.65
1.99
3.29
3.50
2.70
2.30
2.80
2.80
2.60
-
Cereal
Hot
Cold
Cost Total
2.50
3.50
-
# Item Personal Hygiene Cost
Total
Toothpaste
3.00
Toothbrush
4.00
Mouthwash
3.00
Tampons
5.00
Sanitary Pads
4.00
Shampoo
1.50
Conditioner
1.50
Bar soap
1.00
Deodorant (men)
2.50
Deodorant (women)
2.50
Razors
1.00
Shave Crm
2.50
Lotion
6.00
# Pkg
Cleaning Prod.
Dish soap
Dishwasher soap
Laundry soap
Bleach
All purp. clnr.
Glass cleaner
Toilet bowl clnr.
# Pkg
Household Items Cost
Total
Toilet Paper (rolls)
0.75
Paper towel
1.00
Napkins
3.00
Tissues
1.50
Plastic wrap
2.50
Aluminum foil
3.50
Sandwich bags
2.20
Trash bags
0.25
-
# Item Baby items
Diaper (sz NB)
Diaper (sz 1)
Diaper (sz 2)
Diaper (sz 3)
Diaper (sz 4)
Diaper (sz 5)
Diaper (sz 6)
Pullup Boy (sz 2T)
Pullup Boy (sz 3T)
Pullup Boy (sz 4T)
Pullup Girl (sz 2T)
Pullup Girl (sz 3T)
Pullup Girl (sz 4T)
Baby wipes (80)
Grand Total
Cost
Total
2.50
4.00
5.00
3.70
3.60
3.00
3.00
-
Cost
Total
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
0.25
2.50
$
-
We are delighted to share these resources that have been lovingly donated by people and organizations with our community. We are unable to honor requests for specific brands. If
there is a medical necessity, please let us know. Occasionally, when a particular item is not available a suitable substitution may be made.
Voucher amounts earned cannot be given as cash.