Food Share Order Form-November 2017

2. First Name

3. Last Name

5. Address 1

7. Address 2

9. City

10. State

11. Zip

13. Phone Number

14. Email Address

18. Please select your package.

20. Packages

    1. Value Pack $22
    2. Thanksgiving Dinner Box $34
    3. Value Pack + Turkey $44
    4. Harvest Produce Box $16

22. Value Pack Quantity

23. Thanksgiving Dinner Quantity

24. Value + Turkey Quantity

25. Harvest Produce box Quantity

27. Total Payment

    Payment will be processed on the next screen.

28. Payment Method

    1. Credit Card
    2. Check
    3. Cash

30. Checks can also be mailed to Shiloh Baptist Church Food Share 1429 Duke Street, Alexandria, VA 22314

32. Please contact Hughie Jackson at hughiejackson@shiloh-bc.org for additional assistance.

Leave This Blank:


33. Submit Submit and Print

* indicates a required field