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ASAP - Business Directory Participant Form

  1. All Seniors Assistance Program (ASAP)

    ASAP LOGO 631-702-1777

    All Seniors Assistance Program (ASAP) is a new Town service that will provide FREE delivery from participating local stores who do not have their own delivery service. 

    Seniors are the most vulnerable to COVID19. The CDC advises seniors to stay home to reduce the chance of COVID 19 infection. However, trips to the local markets, pharmacies or other retail stores are still necessary. To address this need and to help our seniors remain safe, the Town is providing a new FREE delivery service.


    ARE YOU…

    • Willing to accept phone orders for goods?
      Please note: We cannot deliver prepared meals or perishable goods.
    • Willing to accept credit card payment for an order?
    • Willing to package (15 items or less) orders?
    • Willing to contact the Town’s ASAP number once an order is available for pick up?

    If so, please complete form below to register as a participating business partner in this very important service for our senior population. If you have any additional questions, please call 631-702-1777.

    Residents participating in the program will be preregistered with the Town.

    Important Notice​: Beginning the week of May 18 the ASAP Program will be making deliveries 3 days a week – Tuesday, Wednesdays and Thursdays.

  2. Essential Needs Available at this location

    Check all that apply

  3. Legal Notice*

    The Town of Southampton, its officers and employees shall not be held liable for any loss or damages sustained from any activity associated with the ASAP program and agrees to the 4 delivery items stated above.

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