p Tums ______________________________________

p Pain _______________________________________
p Cold _______________________________________
p Other ______________________________________
p Razors p Shave Cream ______________________
p Shampoo p Conditioner _____________________
p Hair Spray __________________________________
p Other Hair Stuff _____________________________
p Body Wash__________________________________
p Toothpaste p Tooth Brush ___________________
p Mouth Wash p Floss ________________________
p Deodorant __________________________________
p Feminine ___________________________________
p Pads p Liners p Tampons________________
p Wash p Douche _________________________
p Plastic Containers ____________________________
p Tape _______________________________________
p Cleaning Supplies ____________________________
p Bathroom Cleaner p Toilet Cleaner _________
p Kitchen Spray p Sponges p Dish Soap _____
p Laundry Detergent ________________________
p Dryer Sheets p Softener __________________
p Other ___________________________________
________________________________________
p Paper Products ______________________________
p Paper Plates p Paper Towels _______________
p Toilet Paper p Tissues ____________________
p Garbage Bags _______________________________
p Baggies ____________________________________
p Kitchen Wraps ______________________________
p Plastic Utensils ______________________________

p Misc. Household _____________________________

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
p Bottled Water p Jugs ________________________
p Juice p Soda p Milk _______________________
p Eggs_______________________________________
p Butter p Country Crock _____________________
p Yogurt _____________________________________
p Cheese _____________________________________
p Mozzarella p Cheddar p Colby p Slices ___
p Snacks _____________________________________
p Pudding Cups p Apple Sauce p Granola Bars
p Chips p Crackers ________________________
p Other ___________________________________
________________________________________
p Baking Needs _______________________________
p Sugar p Granulated p Powdered p Brown _
p Corn Syrup p Molasses ___________________
p Flour p Corn Starch _____________________
p Baking Powder p Baking Soda _____________
p Bread Crumbs ____________________________
p Other Baking_____________________________
p Spices _____________________________________
p Garlic p Onion p Italian p Parsley _______
p Cinnamon p Marjoram p Tarragon ________
p Thyme p Poultry p Sage p Salt p Pepper
p Dill p Chili p Basil p Oregano __________
p Rosemary p Cumin ______________________
p Other ___________________________________
________________________________________

p Oils _______________________________________
p Olive Oil p Bottle p Spray _______________
p Vegetable Oil p Shortening ________________
p Cereal _____________________________________
________________________________________
________________________________________
p Breakfast Items ______________________________
p Waffles __________________________________
p Toaster Streudels _________________________
________________________________________
p Sides ______________________________________
p Shells p Vermicelli p Mac N Cheese _______
p Rice p Pilaf p Medley ___________________
p Noodles _________________________________
p Other ___________________________________
________________________________________
p Gravy Mix __________________________________
p Broth p Bouillon p Chicken p Beef _________
p Soup ______________________________________
p Egg Noodles p Pasta ________________________
p Pasta Sauce p Tomato Sauce p Tomatoes (Canned)
p Veggies (Canned) ____________________________
p Green Beans p Carrots p Mushrooms ______
p Other ___________________________________
________________________________________
p Condiments_________________________________
p Ketchup p Mayo p Mustard ______________
p Ranch p Italian p Bleu p Thousand Island
p BBQ ____________________________________
p Steak Sauce ______________________________
p Other ___________________________________
p Bread p Rolls p Wraps _____________________
p Jelly p Peanut Butter________________________
p Coffee p Tea p Creamer ____________________
p Chocolate Syrup p Strawberry Syrup ___________

p Frozen Veggies ______________________________

p Broccoli p California p Brussels __________
p Cauliflower p Corn p Peas p Mixed ______
p Green Beans p Pepper Stirfry p Other ______
________________________________________
________________________________________
p Meat
p Chicken Breasts p Thighs p Legs__________
p Pork ____________________________________
p Turkey __________________________________
p Sausage p Dinner p Breakfast _____________
p Bacon p Ham p Hash ___________________
p Beef ____________________________________
p Nuggets p Hot Dogs ______________________
p Fish ____________________________________
p Lunch Meat ______________________________
________________________________________
________________________________________
p Other ___________________________________
p Fresh Veggies _______________________________
p Garlic p Onions p Celery p Potatoes ______
p Carrots p Mushrooms p Peppers __________
p Tomatoes p Squash p Eggplant p Zucchini
p Other ___________________________________
________________________________________
________________________________________
p Fresh Fruit _________________________________
p Apples p Oranges p Peaches p Grapes _____
p Mangos p Bananas p Plums p Mellon _____
p Strawberries p Blueberries p Other ________
________________________________________
________________________________________
p Other ______________________________________
________________________________________
________________________________________
________________________________________

p Tums ______________________________________
p Pain _______________________________________
p Cold _______________________________________
p Other ______________________________________
p Razors p Shave Cream ______________________
p Shampoo p Conditioner _____________________
p Hair Spray __________________________________
p Other Hair Stuff _____________________________
p Body Wash__________________________________
p Toothpaste p Tooth Brush ___________________
p Mouth Wash p Floss ________________________
p Deodorant __________________________________
p Feminine ___________________________________
p Pads p Liners p Tampons________________
p Wash p Douche _________________________
p Plastic Containers ____________________________
p Tape _______________________________________
p Cleaning Supplies ____________________________
p Bathroom Cleaner p Toilet Cleaner _________
p Kitchen Spray p Sponges p Dish Soap _____
p Laundry Detergent ________________________
p Dryer Sheets p Softener __________________
p Other ___________________________________
________________________________________
p Paper Products ______________________________
p Paper Plates p Paper Towels _______________
p Toilet Paper p Tissues ____________________
p Garbage Bags _______________________________
p Baggies ____________________________________
p Kitchen Wraps ______________________________
p Plastic Utensils ______________________________

p Misc. Household _____________________________

________________________________________
________________________________________
________________________________________
________________________________________
________________________________________
p Bottled Water p Jugs ________________________
p Juice p Soda p Milk _______________________
p Eggs_______________________________________
p Butter p Country Crock _____________________
p Yogurt _____________________________________
p Cheese _____________________________________
p Mozzarella p Cheddar p Colby p Slices ___
p Snacks _____________________________________
p Pudding Cups p Apple Sauce p Granola Bars
p Chips p Crackers ________________________
p Other ___________________________________
________________________________________
p Baking Needs _______________________________
p Sugar p Granulated p Powdered p Brown _
p Corn Syrup p Molasses ___________________
p Flour p Corn Starch _____________________
p Baking Powder p Baking Soda _____________
p Bread Crumbs ____________________________
p Other Baking_____________________________
p Spices _____________________________________
p Garlic p Onion p Italian p Parsley _______
p Cinnamon p Marjoram p Tarragon ________
p Thyme p Poultry p Sage p Salt p Pepper
p Dill p Chili p Basil p Oregano __________
p Rosemary p Cumin ______________________
p Other ___________________________________
________________________________________

p Oils _______________________________________
p Olive Oil p Bottle p Spray _______________
p Vegetable Oil p Shortening ________________
p Cereal _____________________________________
________________________________________
________________________________________
p Breakfast Items ______________________________
p Waffles __________________________________
p Toaster Streudels _________________________
________________________________________
p Sides ______________________________________
p Shells p Vermicelli p Mac N Cheese _______
p Rice p Pilaf p Medley ___________________
p Noodles _________________________________
p Other ___________________________________
________________________________________
p Gravy Mix __________________________________
p Broth p Bouillon p Chicken p Beef _________
p Soup ______________________________________
p Egg Noodles p Pasta ________________________
p Pasta Sauce p Tomato Sauce p Tomatoes (Canned)
p Veggies (Canned) ____________________________
p Green Beans p Carrots p Mushrooms ______
p Other ___________________________________
________________________________________
p Condiments_________________________________
p Ketchup p Mayo p Mustard ______________
p Ranch p Italian p Bleu p Thousand Island
p BBQ ____________________________________
p Steak Sauce ______________________________
p Other ___________________________________
p Bread p Rolls p Wraps _____________________
p Jelly p Peanut Butter________________________
p Coffee p Tea p Creamer ____________________
p Chocolate Syrup p Strawberry Syrup ___________

p Frozen Veggies ______________________________

p Broccoli p California p Brussels __________
p Cauliflower p Corn p Peas p Mixed ______
p Green Beans p Pepper Stirfry p Other ______
________________________________________
________________________________________
p Meat
p Chicken Breasts p Thighs p Legs__________
p Pork ____________________________________
p Turkey __________________________________
p Sausage p Dinner p Breakfast _____________
p Bacon p Ham p Hash ___________________
p Beef ____________________________________
p Nuggets p Hot Dogs ______________________
p Fish ____________________________________
p Lunch Meat ______________________________
________________________________________
________________________________________
p Other ___________________________________
p Fresh Veggies _______________________________
p Garlic p Onions p Celery p Potatoes ______
p Carrots p Mushrooms p Peppers __________
p Tomatoes p Squash p Eggplant p Zucchini
p Other ___________________________________
________________________________________
________________________________________
p Fresh Fruit _________________________________
p Apples p Oranges p Peaches p Grapes _____
p Mangos p Bananas p Plums p Mellon _____
p Strawberries p Blueberries p Other ________
________________________________________
________________________________________
p Other ______________________________________
________________________________________
________________________________________
________________________________________