Information Change Form Please submit the following Agency changes:CurrentAgency Name (Current)*Agency NameAgency Number (Current)*Agency NumberNew Name of Food PantryFood Pantry Name (New Name of Food Pantry)New AddressFood Pantry Address (New Address) Physical Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code New DirectorNew Director Name (New Director)New Director Phone NumberPhone Number (New Director Phone Number)Phone NumberEmail (New Director)EmailAdd New Shopper or Phone Number Change for current shopperName (New Shopper or Phone Number Change for current shopper)NamePhone Number (New Shopper or Phone Number Change for current shopper)Phone NumberSection BreakDelete ShopperName (Delete Shopper)NamePhone Number (Delete Shopper)Phone NumberChanges in Days For Distribution of FoodChanges in Days For Distribution of FoodMondayTuesdayWednesdayThursdayFridaySaturdaySundayChanges in Hours of Food DistributionChanges in Hours of Food DistributionMondayTuesdayWednesdayThursdayFridaySaturdaySundayCommentsCommentsPerson Submitting ChangesPerson Submitting Changes*Effective Date For ChangesEffective Date For Changes* Date Format: MM slash DD slash YYYY PLEASE RETAIN A COPY FOR YOUR RECORDSUntitled This iframe contains the logic required to handle Ajax powered Gravity Forms.
