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Fresh Express Home Delivery
Today's Date
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Month
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Day
Year
Date
Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
May we text you at this number?
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Yes
No
What is your street address?
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City
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Redmond
Other
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Fresh Express Deliveries are currently only available for Redmond residents. We are unable to deliver to any other cities, but we are hoping to expand these deliveries to other regions in the future. Would you like us to contact you using the provided phone number if Fresh Express becomes available in your area?
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Yes
No
How many adults are in your household?
How many adults are in your household?
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How many children are in your household?
How many children are in your household?
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Instructions to access residence or apartment building?
Fresh Express Boxes are delivered on Friday between 12-3, will someone be home to receive the box at this time?
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Yes.
No, and I understand that I will not receive temperature sensitive food.
Do you have any allergies or dietary restrictions that we need to be aware of?
What is your reason for requesting a home delivery?
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Limited Mobility
Personal Safety Concerns
Lack of Transportation
Other
Click
here
for TEFAP Guidelines.
Please confirm the following: I understand that by filling out this form, a NeighborImpact Volunteer will receive my personal information. A volunteer will deliver the groceries to my doorstep, but will not be allowed or asked to enter the premises. Staff from NeighborImpact may contact me with additional questions using the contact information provided. I confirm that I fall within the TEFAP eligibility guidelines.
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I agree
I do not agree and understand I will not receive food delivery
Have You received a Fresh Express Home Delivery before?
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Yes
No
Are you submitting this request for your own household?
Yes
No
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What is your relationship to the client household?
Friend or family
Professional Advocate
Other
What organization do you work for?
Fresh Express Home Deliveries may be capped due to weekly capacity. I understand I will be notified if my request will not be delivered this week and I will be put at the top of the list for next week.
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I understand
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