Recipient Location Name * Address * Primary Contact Person * Secondary Contact Person Primary Email - glean notifications are sent by email only! * Secondary Email Office Phone * Mobile Phone Is your organization a Non-Profit? * Yes No Is your organization tax supported? * Yes No Is income verification required for those receiving food?? * Yes No What type of produce would you NOT be able to accept? * How much produce can be accepted at any one time? (usually delivered in 20-25# boxes) * What days can you accept deliveries (M-Sat)? * How many people do you serve? * Do you have specific criteria for selecting people who would receive the produce? * Yes No How frequently can a person/family receive food? * Do you serve meals? * Yes No If so, is there are charge to recipients? Yes No If distributing fresh produce, is there a charge to recipients? Yes No How would you distribute the fresh produce? (ex: specific food pantry distribution days) Can you verify that all fresh produce goes to the food insecure? * Yes No As a Recipient Location Partner, can you: Pick up freshly picked produce at the field/designated location? * Yes No Send/transport people to the field to help glean? * Yes No Assist Haywood Gleaners with printing needs (ex: forms)?? * Yes No Comments Security Code *