Delivery request

If you can pick up resources during walk-up hours at the LIFE Station ( Monday thru Friday 11-3) please do and that would be greatly appreciated. We may have additional resources for walk-up.

LIFE Station delivery area spans 43605, 43609, 43619, 43616 (western half), 43608, 43604, 43607, 43606, 43614, 43611, 43612, 43613, and 43620.

If you need delivery due to health concerns or transportation issues please do not hesitate to request delivery. We definitely want to help you. Fill out the form or call 419-242-3340 and one of our operators will fill out for you. Your delivery will usually arrive up to the next business day. We do require a two day window for delivery. Please plan on being home and available by phone for confirmation.

43605 deliveries will be scheduled with help from New Heights Fellowship Baptist Church of East Toledo which meets at 255 Heffner in Toledo. If you are in East Toledo and Looking for a new church home please give them a try.

Please know that we are simply trying to be good neighbors and we want to assist with resources.

If you are feeding children in your home there is a form that we would like to get signed which allows us to deliver more resources that are especially kid-friendly.

You must be home to receive your delivery for the two day window. If you fail to receive it there are no guarantees of redelivery. We will try to reschedule after other deliveries that have already been requested. Failing to receive a requested delivery multiple times will be grounds for denying all future requests for delivery for a given household. If you are going to be out and about stop by the life station and pick up your free groceries.

Ouside the above listed zip codes deliveries are still possible but manpower and resources are somewhat more limited. Please seek a pantry that is functioning in your area. If there are none, call us. We will look into it and do what we can.

Twenty-Eight days after a LIFE Station delivery or receiving resources from the Life station by picking up from the front door, you may place another request for delivery.

You may not fill out the form for others although you may help someone else fill out the form for themselves. Caseworkers who want to arrange for delivery to a client should reach out to the LIFE Station via telephone directly prior to filling out this form for any clients. Registered Case workers may then fill out multiple forms as needed after authorization. Please do fill out your contact information for follow-up.

If you call 419-242-3340 one of our operators will fill out the form for you and answer any other questions you may have. If an operator is not available when you call you will get voice mail. Please leave a message and wait for a call back. You should receive a call back within 24 hours. We will attempt to deliver your groceries on or before the next day whenever possible.

Should I use this form?*	It has been at least 28 days since I requested delivery or since I or my caseworker picked up food from 402 South Ave. (Life Station)
Delivery or Pick up?*	I am in need of delivery service due to health concerns or lack of transportation (Delivery requires you to be home and allow for a two-day window) I will pick up at the building.
Name*
Address*
City*
County*
Zip Code*
Name of Complex: (type N/A if a house or multi-plex)*
Email Address*
Birthdate*
Marital Status*	married Single Divorced
Gender*	Male female
Voluntarily Identify as a veteran in the house*	Veteran No Veteran Decline to answer
Cell Phone Number*
Can we Send you Texts?*	texts No texts
How many 0-17 yrs old?*
Total # in the Household*
How many 18-59 yrs old?*
How many 60+ yrs old?*
Full name of first additional person
Relationship of additional person
Birthdate of additional person
Full name of second additional person
Relationship of Second additional person
Birthdate of Second additional person
Full name of third additional person
Relationship of third additional person
Birthdate of Third additional person
Full name of Fourth additional person
Birthdate of fourth additional person
Relationship of fourth additional person
Full name of Fifth additional person
Relationship of fifth additional person
Birthdate of fifth additional person
Enter the full name, birthdate, and relationship of any person not yet listed
Please enter the name of your home church if you have one (not required)
If you have a home church how often do you participate?	Never Weekly or more Other Decline to answer
Check all those that apply (not required)	I would identify as a Christian Please send mail-in Bible study for all members of the family (FREE!) Please give me Free streaming Rightnow media Please text me a free link for the audio programs
Do you need a new church home?*	I need a new church home I do not need a new church home Decline to answer
Do you need encouragement?*	I need encouragement (Phone messages and/or texting) I do not need encouragement
Please put your full name here indicating that all information on this form is accurate and you are filling out this form for your own household. If you have requested permission and you are filling out the form for someone else, put your own name here. *
If you are a case worker with permission to fill out this form please list your organization here.
If you are a case worker with permission to fill out this form please list your email and Cell phone number.