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Business Address

Type of Business (Ex. Resteraunt, supermarket etc.)

Business Name

Name of Contact

Email Address of Contact

Phone Number of Contact

Business Hours and Special Instructions (OPTIONAL: Link to Website)

Quantity Avalaible (Ex. 3 Boxes, 12 Cans, 4 Jars, 5 pounds, etc.)

Food Item / Other Goods (Ex. peanut butter, tomatoes, books)

Pickup Date

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