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COVID-19 REQUEST FOR ASSISTANCE

I Need Support

MPCC COVID-19 Help

First Name

Last Name

Email

Phone Number

What Errand Do You Need Help Wih?

Groceries

Household Items (Target, Walmart, CVS, etc.)

Pharmacy

Other

Any Special Instructions?

Full Address

How would you like to pay for the item(s)?

Reimburse with cash or check upon delivery

I have cash or a gift card that I will provide the volunteer before they shop

I accept terms & conditions - by check this box, I agree to accept responsibility to pay for the goods I am requesting upon delivery. I will pay for those in the manner indicated above.

Thank you for reaching out! Someone will be in contact with you soon!

Maple Plain Community Church

info@mpcommunitychurch.org

Access Church Center

1815 Budd Ave N, Maple Plain, MN 55359, USA

(763) 479-1620