PrintNew Agency Inquiry If you are interested in becoming a partner of the Food Bank of Contra Costa and Solano and have questions, fill out the form below and you will be contacted. Agency NameAddress Street Address City State / Province / Region ZIP / Postal Code Executive Director First Last PhoneCellFaxEmail Billing Address Street Address City State / Province / Region ZIP / Postal Code Program NameAddress Street Address City State / Province / Region ZIP / Postal Code Program Director First Last PhoneCellFaxEmail SHOPPER INFORMATION (Name, Title, Phone) **Please include ALL shoppersPlease Choose Type of ServicePantrySoup KitchenResidential ProgramDays and TimesPopulation ServingNotesFor ALL AgenciesWhen did your food program begin or how long has it been operating?How much money do you budget each month to purchase food?Where does this money come from? List sources of funding:Do you have a refrigerator?Do you have a freezer?How do people find out about your program?Does your agency serve a specific population?What are your eligibility requirements?Do you have records of the people receiving food (sign in sheets)?Do you keep your food receipts for at least one year?How many people are currently needed to run your food program?How many people have a current “Servsafe” certification?For Food PantriesHow many households do you serve in an average month?How many individuals do you serve in an average month?What percentage of these people are referred to you?Do you attempt to qualify the people who are not referred?If yes, how?What days and hours are you open?How many times may someone utilize your program in a month?What is the phone number people can call for help?What area do you serve?What is your pantry distribution procedure?For Soup KitchensIs your kitchen liscensed?If yes, by what licensing agency?Which meals do you prepare?How many meals do you serve in an average month?Does your meal count reflect people having a second helping?What percentage of the people you serve are low income?What percentage of the people you serve are repeats?Do you serve one age group in particular?To the best of my knowledge, the information provided above is true and correct.Agency Representative First Last What is your Non-Profit Tax Exempt 9 digit Number (501c3)?CommentsThis field is for validation purposes and should be left unchanged.
