Shopping Services

First name

Last name

Phone

Country/Region

Address

Address - line 2

City

Zip / Postal code

Requested Delivery Date

Requested Delivery Time (Please allow +/- 1 hour)

Time

Veteran/First Responder/Active Duty

Yes

Delivery Notes / Special requests and helpful information for delivery staff.

Substitutions Allowed?

Yes

If NOT allowed and item is not available as described on form it will be skipped.

Produce

Fresh fruits and vegetables (Please advise if Organic is desired)

Beverages

Soda, juices, coffee, tea, water, alcohol, etc.

Dairy

Milk, cheese, yogurt, etc. (Please include size and qty of each item)

Meat/Seafood/Deli

Canned Foods/Starches

Pasta, rice, soups, canned fruits and vegetables, etc.

Sauces/Condiments

Spices, seasoning, salad dressing, etc.

Snacks/Cereals

Chips, candy, cookies, hot/cold cereal, banking, etc.

Frozen Foods

Ice cream. TV dinner/meals, frozen vegetables, etc.

Bakery

Bread, cakes, donuts, etc.

Paper and Cleaning Supplies

Paper towels, plates, laundry soap, dish soap, airfreshener, etc.

Hygiene/Pharmacy

Toothpaste, shampoo, cold medicine, etc.

Pet food and supplies

Misc

Any grocery items not listed above