Restaurant Partner Enrollment Form

Ready to start donating meals to Dinners With Love patients and their families? You can join our program by filling out the form below. If you have questions along the way, please give us a call at 802-465-1027.

The Restaurant

* Indicates required field

Restaurant Name *

Street Address *

City, State *

We would love to donate two meals... *

every week every other week

Please do not order the following items from our menu: *

May DWL schedule meal pick-ups between 3:30 and 5:00 p.m. on Thursdays? *

yes no

If no, please specify your preferred pick-up time. *

Is there anything else we should know about partnering with your restaurant? *

Point of Contact

Name *

Title *

Email *

Phone Number *

Please place orders via... *

email phone

...no later than (specify time; we place orders on Thursdays) *

Thank you for joining the Dinners With Love program! We will be in touch shortly to confirm this information. We look forward to working with you.

Submit