Refrigerator & Freezer Request

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Agency Name * Agency Number * Which Units Do You Need? *

Refrigerator
Freezer
Dual Unit

How Large of a Unit Can You Accommodate? *

Small (5-19 cubic feet) - Dorm Room Size
Medium (20-30 cubic feet) - Single Door, Similar in Size to Household Unit
Large (31-49 cubic feet) - Double Door
Extra Large (50-75 cubic feet) - Triple Door
Other (Please Specify)

Which of the Following Features Do You Need?

Glass Doors
Stainless Steel Doors
Sliding Doors
Hinged Doors
No Preference

What Type of Electrical Outlet Can You Accommodate? *

110v (Standard Outlet Size)
220v (High Voltage - usually used by ovens and dryers)
Either / No Preference
Other (Please Specify)

Please Describe Your Current Need * How Would You Like to Receive Your Unit? *

Pick Up at MANNA
Delivered to Agency ($75 Transportation & Labor Fee)

Submitted By / Contact Person * Phone *

Email * Preferred Contact Method *

Phone
Email

I agree to respond to the MANNA representative through my listed preferred method of communication within a week of initial contact about a unit. If no return contact is made (through email, phone message, or direct phone contact with the MANNA Thermo Fisher representative), I acknowledge the previously held unit will be assigned elsewhere. *

Yes, I Agree.

If picking up the unit, I agree to do so within a week of it being officially assigned to my agency, or else the unit will be assigned elsewhere. *

Yes, I Agree.

Does your 501(c)(3) serve food from The Emergency Food Assistance Program (TEFAP)? *

I agree that the unit requested comes "as-is" and that no returns will be allowed. *

Yes, I Agree.

Send Request