Share Food Program
Serving: Pennsylvania, Delaware
New Jersey and the Maryland Eastern Shore

EBT / Food Stamp Voucher Submission

1.  Fill in the RED section to the left - all 5 lines
2.  Fill in up to 7 voucher units at one time.

Merchant ID/Host # Voucher #
Your Name $ Amount #
Your Email Approval #
Your Host Name: Card #
Your Phone: Card Holder Name
Voucher # Voucher #
$ Amount # $ Amount #
Approval # Approval #
Card # Card #
Card Holder Name Card Holder Name
Voucher # Voucher #
$ Amount # $ Amount #
Approval # Approval #
Card # Card #
Card Holder Name Card Holder Name
SECURITY CHECK: Enter the letters and numbers you see in the box to the right.  This helps prevent spam robots from using our form.