subject_line
Meals 4 Members Request
I am requesting a meal delivery for
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my family
another Todd-Wadena Electric Cooperative member's family
First Name
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Last Name
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Address
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City
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Phone Number
*
Type of Phone
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Cell Phone
Home Phone
Number of people in household
*
My primary residence is served by Todd-Wadena Electric Cooperative?
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Yes
No
Information about the person making the request
First Name
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Last Name
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Address
*
City
*
Phone Number
*
Type of Phone
*
Cell Phone
Home Phone
I would like to request a Meals 4 Members delivery to:
First Name
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Last Name
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Address
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City
*
Phone Number
*
Type of Phone
*
Cell Phone
Home Phone
Number of people in household
*
I understand that my request will be added to a list for delivery. I understand that my one-time grocery delivery will take place during one of the meal delivery dates during the February 1- April 9th timeframe.
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Yes
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