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Your Contact Information

Name: *

Phone Number: *

Email: *

Delivery For:

Preferred Local Supermarket to use: *

If Other - Please Specify

Delivery Address:

Preferred Delivery Date:

Preferred Delivery Time:

Special Instructions or Comments:Please provide all relevant information in regards to delivery.

Your Grocery List

Please fill out your grocery list below. If known or preferred please specify: Quantity, Size, Brand Name, and Product Description.

Example:

Qty 6 - Granny Smith Apples
Qty 5 - Oranges
Qty 1 - Tide Laundry Detergent - 50 oz

Produce:Fruits, Vegetables

Deli:

Bakery:Bread, Rolls, Tortillas, Bagels, Cakes, Donuts, etc.

Meat & Seafood:

Dairy:Cheese, Eggs, Milk, Yogurt, Butter, etc.

Beverages:Coffee, Tea, Juice, Pop, etc.

Canned & Jarred Goods:Vegetables, Spaghetti Sauce, Ketchup, etc.

Dry & Baking Goods:Cereals, Flour, Sugar, Pasta, Mixes, etc.

Frozen:

Paper Goods:Paper Towel, Toilet Paper, Aluminum Foil, Sandwich Bags, etc.

Pet Supplies:

Baby Goods:

Personal Care:Shampoo, Soap, Shaving Cream, etc.

Cleaners & Other Household Goods:All Purpose Cleaners, Laundry Detergent, Dish Washing Detergent, Batteries, etc.

Pharmacy:

Alcohol & Tobacco:Wine, Beer, Liquor, Cigarettes, etc.

Additional Miscellaneous Items (If Any):

Substitute out-of-stock items with comparable items?

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