Information Change Form Information Change Form Please fill in the changes that need to be made:Agency Name (If Applicable)* Agency Name (If Applicable)Food Pantry Address* Physical Address City State Zip Code Director's InformationFirst FirstLast LastDirector Phone Number* Director Phone NumberEmail (New Director)* EmailShoppers and Contact NumbersDelete Shoppers?Would you like to delete shoppers? Yes No The following shoppers will be DELETEDName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberAdd Shoppers?Would you like to add shoppers? Yes No The following shoppers will be ADDEDName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberName (New Shopper or Phone Number Change for current shopper) NamePhone Number (New Shopper or Phone Number Change for current shopper) Phone NumberSection BreakDays of Distribution (Please place an "X" on the days of operation)Days For Distribution of FoodMondayTuesdayWednesdayThursdayFridaySaturdaySundayHours of Operation (Please indicate the hours of operation on the days you are open)Changes in Hours of Food DistributionMondayTuesdayWednesdayThursdayFridaySaturdaySundayCommentsComments Person Submitting ChangesPerson Submitting Changes* Date of SubmissionEffective Date For Changes* MM slash DD slash YYYY PLEASE RETAIN A COPY FOR YOUR RECORDS