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Gift Card Request Form

Please complete this form to request gift cards for your friends and neighbors in need. Each family can request up to 4- $100 grocery gift cards while funds are available.

Your name *

Last name

Email address *

Phone number

Phone type

Gift Card #1

Please add the name of the family who will receive this gift card.

Name *

Grocery Store Name

Which grocery store would you prefer?

Safeway

Smart n Final

Target

Gift Card #2

Please add the name of the family who will receive this gift card.

Name *

Grocery Store Name

Which grocery store would you prefer?

Safeway

Smart n Final

Target

Gift Card #3

Please add the name of the family who will receive this gift card.

Name *

Grocery Store Name

Which grocery store would you prefer?

Safeway

Smart n Final

Target

Gift Card #4

Please add the name of the family who will receive this gift card.

Name *

Grocery Store Name

Which grocery store would you prefer?

Safeway

Smart n FInal

Target

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The River Church Community
info@the-river.org
408-252-5500

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