Eligibility for C3/Your Bargain Grocer Food Voucher:
Need for Additional Services
Please List Any or All Exigent Circumstances (housing insecurities, transportation issues, need for child care, etc.):
For more information about Your Bargain Grocer including hours of operations and specials, please visit http://www.yourbargaingrocer.com/ or visit their Facebook page.
IT IS UNDERSTOOD AND AGREED THAT THE C3/YOUR BARGAIN GROCER PARTICIPANT ACCEPTS AND AGREES TO THE TERMS OF THE VOUCHER AND POLICIES OF YOUR BARGAIN GROCER.
Signature(Please type your name):