FoodShare New Customer

Pick-Up Site

Date

First Name

Last Name

Address

City

State

ZIP code

Phone Number (cell phone with text message capabilites preferred)

Opt in for to receive text messages

Information message

Text messages are the main tool for communicating payment options and reminders. You will receive a Welcome text message from FoodShare Berkeley County once enrolled. You may opt out of receiving messages, but you will be responsible for remembering payment and pickup deadlines.

Do You Receive EBT/SNAP?

Yes

Opt in for SNAPonline (to pay online)

Allow emails (must select for SNAPonline)

Information message

Opting out of answering the questions below will NOT affect your ability to receive fresh food boxes from FoodShare. All information given is only used to help FoodShare continue to receive grant funding. Completing the section below is OPTIONAL.

How did you hear about FoodShare?

Berkeley Resource Connection Center

Trident United Way website

Friend/Neighbor/Family member

Other…

Other

Ethnicity

Year of Birth

Number of people in household?

Under 17

18-64

65+