Mobile Meals - Client Agreement

Mobile Meals of Salem will deliver meals to a Salem or Perry Township resident either five days of week (Monday through Friday), three days a week (Monday, Wednesday, or Friday), or on an agreed upon schedule.

Meals are delivered between 11:00 a.m. and 12:30 p.m. on the meal plan selected. Someone MUST be at the home to accept delivery of the meal or the cost of the meal will be forfeited.

The cost of each meal delivery is $5.25 (for 2 people that is $10.50). Payment MUST be made on a monthly basis one month in advance and is due by the 15th of each month. Payment must be by check and can be mailed to the Mobile Meals office or given to the person who delivers the meal.

If you do not receive the number of meals already paid for, you will receive credit on the next billing.

If you need to cancel a meal delivery, you MUST call the Mobile Meals office at 330-332-2160 before 11:00 AM on the last business day before the meal is to be delivered or you will be responsible for the cost of the meal. Meals scheduled for delivery on Monday must be cancelled by Friday and meals scheduled after a holiday must be cancelled the last business day before the holiday.

Meals are not delivered on weekends of the following holidays: Memorial Day, 4th of July, Labor Day, Thanksgiving, the Friday after Thanksgiving, Christmas Eve, Christmas Day, and New Years Day. In addition, when one of the designated holidays falls on a Thursday, meals will not be delivered on the following Friday.

Meal Delivery

Requested Delivery Days:
Comments (optional):

Client Information

Client Name: Date of Birth:
Referral (optional): Diet Type:
Help me Decide
  • Regular - a healthy mix of foods
  • Diabetic - a mix of foods low in fat and calories including fruits, vegetables and whole grains
  • No Added Salt - 4 gram sodium diet which excludes foods high in sodium like cured meats, canned meats, vegetables or soups and pickles (note, clients should not use table salt)
  • Diabetic No Added Salt - combination of Diabetic and No Added Salt
Reason (optional):
 
Optional Client 2: Date of Birth:
Referral (optional): Diet Type:
Help me Decide
  • Regular - a healthy mix of foods
  • Diabetic - a mix of foods low in fat and calories including fruits, vegetables and whole grains
  • No Added Salt - 4 gram sodium diet which excludes foods high in sodium like cured meats, canned meats, vegetables or soups and pickles (note, clients should not use table salt)
  • Diabetic No Added Salt - combination of Diabetic and No Added Salt
Reason (optional):
 
Delivery Address: Cell Phone:
City, State Zip: Home Phone:
Comments (optional):
 
Billing Name: Cell Phone:
Billing Address: Home Phone:
City, State Zip:
Comments (optional):
 

Contact(s) in Case of Emergency

Name: Telephone:
Name: Telephone:

Mobile Meals strives to provide quality food at an affordable price but is not responsible for the quality of the food delivered.

I agree to hold Mobile Meals, its volunteer drivers and food suppliers free and harmless against any and all claims, loss, cost, damages or liability on account of any damages or injury to person or property occasioned by the acts of said Mobile Meals, its duly authorized agents or suppliers.

Full Name: Date:
Email (optional):

Click HERE to print a copy for your records.

Click HERE to submit your request to Mobile Meals.

Then call Mobile Meals at 330-332-2160 Mon-Fri 9:30am-12:30pm to select the starting date
and to arrange for payment of your meals for the upcoming month.

 

Mobile Meals of Salem, Ohio

1995 East State Street

Salem, Ohio 44460

330-332-2160

info@salemmobilemeals.com