Agency Pick Up Report

Agency Pick Up Form For The Northwest Arkansas Food Bank

Name:

Date:

Email:

Agency Name

Reporting Week (Week Starts Monday)

Store Name/Location

04-1000 BP:

31-1000 DELI:

28-1000 PROD:

15-1000 MEAT:

07-1000 DAIRY:

23-1000 EGGS:

16-1000 SAL:

Non-Food:

Store Name/Location

04-1000 BP:

31-1000 DELI:

28-1000 PROD:

15-1000 MEAT:

07-1000 DAIRY:

23-1000 EGGS:

16-1000 SAL:

Non-Food:

Store Name/Location

04-1000 BP:

31-1000 DELI:

28-1000 PROD:

15-1000 MEAT:

07-1000 DAIRY:

23-1000 EGGS:

16-1000 SAL:

Non-Food:

For more information on Feeding America please visit: www.feedingamerica.org

NWAFB is a 501(c)3 nonprofit organization, all donations made are tax exempt. TIN# 71-0680830

NAVIGATION

CONTACT INFO

1604 Honeysuckle Street

PO BOX 2126

Lowell AR 72745-2126

Phone (479) 872-8774

Fax (479) 872-8777

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