Assignment Form

Please complete this form when purchasing a Food Pack Subscription or One Time Food Pack.

Fields marked with * are required.

First Name

Last Name

Do you want to purchase food packs for a specific family? If you select No, your purchase will be given to the family with the greatest need.

Yes

If you selected Yes, please provide information about the family (Name, Casa, family members, etc.)

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SEEN International
513 US HWY 60 EAST PMB 2027
REPUBLIC, MO 65738
(816)273-0340