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

Lettuce

Onions

Beets

Cabbage

Green Bell Peppers

Butternut Squash

Spaghetti Squash

Long Pie Pumpkin Squash

Apples

Bananas

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.)

Chicken Boned Pouch 10 oz. pouch

Beef Chili without Beans, 24 oz. pouch

Beef Stew, 24 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

Oat Rings

Honey Rings

Honey Nut Rings

Corn Flakes

Shredded Wheat

Toasted Wheat

Bran Cereal

Crispy Rice

Blueberry Cinnamon

Assorted Cereal; 7 individual packs = 1 large

Oatmeal, Variety Pack, 10/1.23oz packets

Healthy Cereal

Sweet Cereal

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.)

Corn

Collards

Spinach

Peas

Mixed Vegetables

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.)

Black Beans

Garbanzo Beans

Kidney Beans

Pinto 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

Canned Fruit

Select the number of each cans 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

Mixed Fruit

Dried Plums

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,

Canned Salmon

Condiments

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

Dried Items

Lentils

Dried Pinto Bean

Spaghetti

Penne Pasta

Elbow Macaroni

Mac & Cheese

Mashed Potatoes, 1 lb. box

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.)

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

Pecans, 1 lb. Bag

Almonds, Natural Whole Shell, 2 lb.

Whole Wheat Flour, 5 lb. bag

Chips

Muffin Mix

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)

Pulled Pork, 2lb

Pork Chops, Boneless, 4 pk., 1 lb.

Pork Chops

Beef

Steak

Ground Beef

(1 lb)

Fish Sticks (Pollock) Breaded, 2 lbs

(2 lbs)

Fish Pollock Fillet 2 lbs

(2 lbs)

Chicken Drumsticks, 20 oz.

Miscellaneous packages of Chicken

Miscellaneous packages of Lamb

Miscellaneous packages of Pork

Dairy / Frozen Items

Milk, half-gallon

Eggs

American Cheese, 2 lb. block

Breaded Mozzarella Sticks, 64 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 baby(Required)

Enter the diaper size and gender for the adult(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

18504

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	Baked Beans	Tuna
Boxed Potatoes	Canned Fruit	Vegetable Oil
Coffee & Tea	Pancake Mix	Sryup
Baked Goods Cake Mix Brownie Mix Muffin Mix Flour & Sugar	Personal Care Shampoo, Deodorant, Bar Soap, Tooth Paste	Condiments Ketchup, Mayo, Mustard, Dressing
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

Baked Beans

Tuna

Boxed Potatoes

Canned Fruit

Vegetable Oil

Coffee & Tea

Pancake Mix

Sryup

Baked Goods Cake Mix Brownie Mix Muffin Mix Flour & Sugar

Personal Care Shampoo, Deodorant, Bar Soap, Tooth Paste

Condiments Ketchup, Mayo, Mustard, Dressing

Nutritional Drinks Ensure/Boost Regular & Glucose Control

Gift Cards to Adams IGA

Help Reduce Hunger By Donating Today!