Fresh Meals On Wheels - Service Request Form Are you a current client? * Yes, I am a current client No, I am a not a current client I am making this request on behalf of an existing client (Please enter your contact info below) I am making this request for a new client (Please enter your contact info below) Referrer Information Referrer Name Relationship to client / Name of referring organization Telephone Number Email address Client Information First Name Last Name Telephone Number Email address Please note that the meals are delivered Monday to Friday, excluding statutory holidays. The cost is $7.50 per meal including taxes and delivery. I would like meals delivered on the following days Monday Tuesday Wednesday Thursday Friday Requested start date for meal delivery Please confirm your delivery Address If you would like to order meals for individual dates from our monthly calendar please select the dates below: Wednesday October 28th 2020 Thursday October 29th 2020 Friday October 30th 2020 Message (If you would like more than 1 meal per day please specify the number of meals in the message box below): Send Hot Meals Request Once your Hot Meals on Wheels request has been sent, a Community Support Services Coordinator will contact you within 1 business day to confirm if we can accommodate your service request.
