Mobile Food Pantry Report

Agency Name

Agency Number

Person Filing

Phone Number

Enter the total number of households served for the month from each county.

Households Served

Re-order	County	Number of Households	Weight	Operations
	County	Number of Households	Item weight

more items

Enter the total number of individuals served for the month from each county.

Individuals Served

Re-order	County	Number of Individuals	Weight	Operations
	County	Number of Individuals	Item weight

more items