Agency Pound Tracker

Pick-Up Person's Name

First Name

Last Name

Agency Name

If agency is not listed choose OTHER -- then write Agency's Name in the comments section

Who are you primary serving with the food donation?

Choose the majority served.

How many people will you serve with the donation?

What will you use this food donation for?

Choose one

Total Pounds Given

Donation Description

Only write items given not pounds

Did agency honor pick-up time?

If no please explain in the comments

Notes/Comments

Check Out

First Name

Last Name

“Gather the pieces that are left over. Let nothing be wasted.” John 6:12