Order Food

Order Form

The Plymouth Community Food Pantry offers this form to help you access the foods you prefer. We will do our best to update the choices available every Wednesday afternoon after receiving our delivery. Simply complete the form and “SUBMIT”. You will receive an acknowledgement that your order has been received. We will contact you as soon as possible to set up an appointment for curbside pick-up. If you do not receive an item that you requested, it is because our stock has been depleted.

Name(Required)

First Last

Number of People in Household(Required)

Phone(Required)

Date You Plan to PICK-UP Order or Recieve Delivery(Required)

MM slash DD slash YYYY

Do you need your order delivered?(Required)

Yes

Delivery Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Enter any dietary restrictions you may have

Volunteer Take Note of comments on last page of order form

Select the produce you would like

Iceberg Lettuce

Carrots

Potatoes

Onions

Bell Peppers

Oranges

Nectarines

Plums

Limes

Volunteer, Did You Take Note of comments on last page of order form or dietary restristrictions listed above?

Canned Pasta, select the number of cans you would like

Canned/Pouched Meats or Stews

Select the number of cans/pouches you would like. (1-4 people households maximum is 2 cans/pouches, 5 people or more households maximum is 3 cans/pouches.)

Beef Stew, 24 oz. pouch

Chicken Boned, 10 oz. pouch

Canned Beef, 24 Oz.

Canned Pork with Juices, 24 Oz.

Baked Beans, select the number of cans you would like

Select the ceral you would prefer

Corn Flakes

Crispy Rice

Oatmeal, Variety Pack, 10/1.23oz packets

Fruit Loops

Blueberry Clusters

Apple Jacks

Chocolate Crunch

Peanut Butter Crunch

Special K

Cherrios

Swiss Muesli

Cinnamon Instant Oatmeal, 9.7 oz., 2 bags

Canned Vegetables

Select the number of cans you would like. (1-2 people household maximum is 3 Cans, 3-4 people household maximum is 4 Cans, 5 people or more household maximum is to 6 cans.)

Spinach

Collards

Sweet Peas

Corn

White Potatoes, Sliced

Green Beans

Assorted Beans

Select the number of cans you would like. (1-4 people household maximum is 2 Cans, 5 people or more-household maximum is 3 cans.)

Kidney Beans

Pinto Beans

Black Beans

Garbanzo Beans

Soups

Select the number of cans you would like. (1-2 people household maximum is 2 Cans, 3-4 people household maximum is 3 Cans, 5 people or more household maximum is 4 cans.)

Vegetable

Chicken Noodle

Tomato

Chicken Broth

Canned Fruit

Select the number of each can or bag you would like. (1-2 people household maximum is 2 Cans, 3-4 people household maximum is 2 Cans, 5 people or more household maximum is 3 cans.)

Apple Sauce

Dried Plums

Sliced Peaches

Dried Figs

Pears

Cherries, Dried, 2lbs.

Raisins

Volunteer, Did You Take Note of comments on last page of order form or dietary restristrictions listed above?

Would you like White Rice?

Yes

Canned Fish or Chicken

Select the number of cans you would like. (1-2 people household maximum is 2 Cans, 3-4 people household maximum is 3 Cans, 5 people or more household maximum is 4 cans.)

Canned Tuna,

Canned Chicken

Condiments

List the type of condiments you would like in the field above. (e.g. salad dressing, mustard, barbecue sauce, mayonnaise, etc.)

Dried Items

Lentils

Dried Pinto Bean

Dried Garbanzo Bean

Fig Pieces

Elbow Macaroni

Mashed Potatoes, 1 lb. box

Spaghetti

Pantry Items

Peanut Butter

Grape Jelly

Pancake Mix

Pancake Syrup

None

Select 2 of these items, or none.

Select the number of Tomato Sauce cans/jars

(1-4 people households, maximum cans is 2, 5 and up households maximum is 3 cans.)

Select the number of Diced Tomato cans

(1-4 people households, maximum cans is 2, 5 and up households maximum is 3 cans.)

Are there members of your household 65 years or older?(Required)

Yes

How many household members are 65 years or older?(Required)

Name(Required)

First Last

Name(Required)

First Last

Name(Required)

First Last

Select two personal care items

Disposable Wash Cothes

Flushable Wipes

Body Wipes

Bar Soap

Shampoo

Conditioner

Body Wash

Deodorant

Body Lotion

Foot Cream

Denture Grip

Denture Tablet Cleaner

Tooth Brush/Tooth Paste

Mouth Wash

Shaving Cream

Razors

Shower Caps

Nail Clipper

Alcohol Swabs

Rubbing Alcohol

Hydrogen Peroxide

Band Aids

Sensitive Toothpaste

Lens Wipes

Arthritis Pain Relief Creme

7-Day Pill Organizer

One-Time Products

Bath Mat

Grabber

$10 Voucher to Thomaston Pharmacy for Vitamins, probiotics, or supplements

Personal Items

List the type of personal items you would like in the field above. (e.g. deodorant, tooth paste, soap, etc.)

Household Items

List the type of household items you would like in the field above. (e.g. laundry detergent, dish soap, glass cleaner etc.)

Feminine Hygiene items

List the type of feminine hygiene items you would like in the field above.

Various Items

Dog Food

Cat Food

Cat Litter

Cat Bed Liners

Boxed Milk

Chips

None

Drink Items

List the type of drink items you would like in the field above. (e.g. water, juice, flavored water, ice tea, We Have Shelf Stable Chocolate Milk (8 oz.)etc.)

Nutitional Drinks

We provide nutritional drinks to customers struggling to maintain a healthy weight or trying to manage blood sugar. (Often doctors or nutritionist have recommended that these drinks be used by our customers. The Food Pantry reserves the right to ask for medical proof from a doctor before dispensing these drinks.)

If you are struggling to maintain a healthy weight due to:
1. loss of appetite
2. cancer
3. swallowing problems
4. recovery from recent surgery

Then select Regular Nutritional Drinks below.

If you are a diabetic or are struggling to manage blood sugar and a healthy weight., then select the Glucose Control Drinks below.

We provide 4 drinks per households. If more than one resident needs theses drinks, specify the number of each type needed.

Select the type of Nutritional drink needed and the quantity. 4 per household.

Regular Nutritional Drinks

Select the type of Regular Nutritional Drink needed and the quantity. 4 per household.

Glucose Control Drink (Glucerna, Boost Blue Label)

Select the type of Glucose Control Drink needed and the quantity. 4 per household.

Bread and Pastry Items

Enter the type of bread and pastry you would like.

Meat / Poultry / Fish

(1-2 people households maximum is 3, 4-5 people households maximum is 4, 5 or more people households maximum is 5)

Pork Chops

Chicken Drumsticks, 3 lbs.

Miscellaneous packages of Chicken

Cornish Hen

Beef

Fish Pollock Sticks, Breaded, 2lbs,

(2 lbs)

Fish Pollock Fillet, 2lbs,

(2 lbs)

Miscellaneous packages of Pork

Miscellaneous packages of Lamb

Steak

Ground Beef

(1 lb)

Dairy / Frozen Items

Milk, half-gallon

Eggs

Yogurt, Assorted Flavors, 5.3 oz.

Select the dairy/frozen items you would like

Diapers

Baby Diapers

Adult Diapers

Check the appropriate box if you need diapers for a member of the household.

Enter the diaper size and gender for the adult(Required)

Enter the diaper size and gender for the baby(Required)

Bed Liners

Yes

Do you need Bed Liners?

Baby Food

Yes

Do you need Baby Food? (if yes, please plan to come in and select)

Comments or Other items needed, select Yes

Yes

Comments or Other Items needed

Name

First Last

Donate

Every household pantry runs low at some time. The Plymouth Community Food Pantry is no different. You can help us by donating some of the items listed below. These items hardly ever change because we seldom receive them from our partner, Connecticut Foodshare. We usually purchase them. Your thoughtfulness is appreciated

Drop-Off Points

Plymouth Community Food Pantry

20 Dewey Ave., Terryville, Mon. & Wed. 1 hour before opening

Plymouth Volunteer Ambulance Corp.

191 Main St., Terryville, Rear Lobby

Adams Hometown Market

331 Main St. Terryville, basket by cash registers

Kids Cereal	Oatmeal	Canned Pasta & Ravioli
Canned Soup Chicken Noodle and Thick Soups	Baked Beans	Tuna
Macaroni	Canned Vegetables Corn, Green Beans, & Mixed Vegetables	Jelly
Pasta Sauce	Whole Tomato Crushed Tomato	Tomato Paste Diced Tomato
Rice	Macaroni & Cheese	Coffee & Tea
Pancake Mix	Sryup	Condiments Ketchup, Mayo, Mustard, Dressing
Baked Goods Cake Mix Brownie Mix Muffin Mix Flour & Sugar	Personal Care Shampoo, Deodorant, Bar Soap, Tooth Paste	Nutritional Drinks Ensure/Boost Regular & Glucose Control
Gift Cards to Adams IGA

Donate Today or Get Involved

Please leave this field empty.

Name

Help Reduce Hunger By Donating Today!

Make a Donation

Order Form

Canned/Pouched Meats or Stews

Canned Vegetables

Assorted Beans

Soups

Canned Fruit

Canned Fish or Chicken

Nutitional Drinks

Meat / Poultry / Fish

Donate

Drop-Off Points

Kids Cereal

Oatmeal

Canned Pasta & Ravioli

Canned Soup Chicken Noodle and Thick Soups

Baked Beans

Tuna

Macaroni

Canned Vegetables Corn, Green Beans, & Mixed Vegetables

Jelly

Pasta Sauce

Whole Tomato Crushed Tomato

Tomato Paste Diced Tomato

Rice

Macaroni & Cheese

Coffee & Tea

Pancake Mix

Sryup

Condiments Ketchup, Mayo, Mustard, Dressing

Baked Goods Cake Mix Brownie Mix Muffin Mix Flour & Sugar

Personal Care Shampoo, Deodorant, Bar Soap, Tooth Paste

Nutritional Drinks Ensure/Boost Regular & Glucose Control

Gift Cards to Adams IGA

Help Reduce Hunger By Donating Today!