Direct Distribution Interest Form Thank you for your interest in becoming a direct distribution partner with the Food Bank of Contra Costa and Solano. Please complete the below form and someone from our Program Team will follow up. Direct Distribution Application Distribution SiteProposed Distribution Site Name* Site Website* 501c3 Non-Profit Tax Exempt 9-digit number (EIN)Site Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Site ContactSite Contact Name* First Last Site Contact Work/Home Phone*Site Contact Mobile Phone*If same as Work/Home Phone, please reenter the same number. Site Contact Email* FOOD DISTRIBUTION DETAILSSelect the type of distribution you would like to host. Program overviews can be found at foodbankccs.org/about/our-programs/Type of Food Distribution Program Interest* (select one)* Community Produce Program Farm 2 Kids Mobile Food Pharmacy School Pantry Program (50% or more of your students must be eligible for free or reduced-price meals) Senior Food Program Is your location open to the general public?* Yes No Does a Food Bank sponsored distribution currently take place at this site?* Yes No If yes, select program (select all that apply) Community Produce Program Food Assistance Program Farm 2 Kids Food for Children Harvest to Home Mobile Food Pharmacy School Pantry Program Senior Food Program Do you have any additional food resources on site?* Yes No Briefly describe the other food resources on site*TO THE BEST OF MY KNOWEDGE, THE INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT.* Site Representative* First Last Email address where we should send confirmation.* PhoneThis field is for validation purposes and should be left unchanged.