Meal Service Sign-Up 2017-08-04T21:33:12+00:00

Meal Service Sign Up

This sign up form is per client. You must complete a new form for each client you are signing up. This form is for Private Pay clients ONLY. If you require financial assistance, you must call our office at 505-823-8082 between 9am – 2pm, Monday – Friday to inquire about grant availability. Click here to return to the Meal Service information page.

Please fill out all information. A Client Services Coordinator will call to confirm your start date.









MaleFemale


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Add breakfastAdd dinner


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*All deposits are non-refundable. Service will not start until after payment has been received.

A 10 meal deposit is required prior to starting service.
If you are receiving HOT meals, please pay $65.00.
If you are receiving FROZEN meals, please pay $57.50

If sending a check:
Be sure to include the client name and the word “DEPOSIT” on the check.
Write this Address Down if Sending a Check
PO Box 92614, Albuquerque, NM 87109


Please Check this box to indicated acceptance of these terms and that you have recorded the address to mail checks to.