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Food Donation Signup Form
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Business name
*
Nature of business
Restaurant
Café
Food Truck
Catering Service
Bakery
Deli
Grocery Store
Meal Prep Service
Ice Cream Shop
Food Delivery Service
Pop-up Restaurant
Farmers Market Stand
Pizzeria
Juice Bar
Ethnic Cuisine Restaurant
Vegan Restaurant
Buffet
Fine Dining
Fast Casual
Barbecue Joint
Seafood Market
Sushi Bar
Coffee Shop
Bistro
Catering Truck
Popcorn Stand
Dessert Shop
Address
*
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone
*
Business email - not the same as contact person
*
minutes) Picture
Number of daily meals for donation
*
Cost price $ (COGS)
*
Retail price $
*
Tax receipt required
Yes
No
Average weight of meal in lbs
*
SB-1383 documentation required
Yes
No
Preferred pick up window (min 15 minutes)
*
Special instruction for pickup
Business Closed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Product types
Vegan
Vegetarian
Allergy friendly
Contains nuts
Diary
Kosher
Halal
Organic
Free range
Gluten free
Sea food
Spicey
Short description of what type of food to expect
*
Website / URL
Preferred social media (Instagram, Facebook etc.)
Contact person
*
Contact person phone
*
Contact person email
*
Picture upload
Drag & Drop Files,
Choose Files to Upload
You can upload a picture of your Business which will show on the EatWell App
Submit
