Name *

First Name

Last Name

Phone *

(###)

###

####

Do you live in Lower Merion Township? *

Yes

No

How can we help? *

Please check all that apply.

Local Weekly Food Delivery

Basic Needs Items

Resource Connection

Saturday Pop Up

Other (Please specify below)

Household deliveries are made every Thursday. Do you need a starter package delivered before then?

Yes

Do you have a female head of household? *

Yes

No

I confirm all information provided is true and correct from date of initial service by NHN. *

Confirm