General 1 — Piece

Taking that first step to ask for help can be hard. There are people in your community that want to get you what you need.

We need to gather some info, but we won’t ever share it with anyone. Period. There will be no indication that you received any assistance at all.

Here’s How It Works.

Fill out this form.

Once your form has been received, we will add your request to the list of needed items. Once the order has been received, please give us some time to process it. If you don’t hear anything within 1 week, please reach out by emailing help@pieceapp.org. Once the order is ready, the grocery store will notify you that your order is ready for pickup. That’s it. For now, it will say that it was paid for by piece, but we will change that as we grow.

Right now, we cannot accommodate food allergies or special requests. All of the items listed will be provided as described, cannot be modified, or returned. Your request is voluntary and does not guarantee the fulfillment of the request.

Name

First Name

Last Name

Phone

(###)

###

####

Address

This is so we can place the order with the store

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Local Grocery Store Name and Address

I Need

Bread

5 lbs. Rice

18 Eggs

Gallon of Milk

Cheddar Cheese

Baby Formula

10-24 lb. Turkey (No guarantee on weight or size, depending on availability)

1 lb. Ground Beef

28 oz. Peanut Butter

Any Questions?

Let us know of any questions or concerns.

Best Time for Pickup

We'll do our best to get the best time possible and as soon as we can.

I Need Help

Taking that first step to ask for help can be hard. There are people in your community that want to get you what you need.

We need to gather some info, but we won’t ever share it with anyone. Period. There will be no indication that you received any assistance at all.

Here’s How It Works.

Fill out this form.