Charitable Institutions for the Emergency Food Assistance Program Sample Clauses

Charitable Institutions for the Emergency Food Assistance Program. Non-penal, non-educational public, state and local Xxxxxxx 00, 000 - Xxxxxxxxx tax-exempt private hospitals; other nonprofit, non-educational Section 32, 416 tax-exempt private institution organizations for charitable purposes - Nonprofit organizations which service 50% or more needy population Section 110 * Approval Agency Xxxxxxx/Merrimack CAP Signature of Authorized Representative of Recipient Agency Title Federal Surplus Manager Signature of Authorized Representative of Surplus Distribution Section Title Approved and Certified by Surplus Distribution on MONTH DAY YEAR ADDRESS FORM COMPLETE ALL INFORMATION BELOW (Please Print or Type): Customer Number: Facility Name: Lunch Director: Contact for commodities: __ Phone Number E-mail address: WBSCM Contact (if different from above) __ E-mail for WBSCM Contact person for accounts payable: Telephone Number: E-mail address for invoices: Billing Address: Delivery Address: ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------ Customer Number: Facility Name: Lunch Director: Contact for commodities: Phone Number E-mail address: WBSCM Contact (if different from above) E-mail for WBSCM Contact person for accounts payable: Telephone Number: E-mail address for invoices: Billing Address: Delivery Address: ----------------------------------------------------------------------------------------------------------------------------- ----------------------------------- Customer Number: Facility Name: Lunch Director: Contact for commodities: Phone Number E-mail address: WBSCM Contact (if different from above) E-mail for WBSCM Contact person for accounts payable: Telephone Number: E-mail address for invoices: Billing Address: Delivery Address: - ----------------------------------------------------------------------------------------------------------------------------- ------------------------------------ If additional space is needed, please use the Address Form Continuation Sheet ADDRESS FORM CONTINUATION SHEET Use as a continuation sheet to page 4 of the Agreement or copy and use whenever you have a pertinent change to report. COMPLETE ALL INFORMATION BELOW (Please Print or Type): Customer Number: Facility Name: Lunch Director: Contact for commodities: Phone Number E-mail address: WBSCM Contact (if different from above) E-mail for WBSCM Contact person for accounts payable: Telephone Number: E-mail address for invoic...