Date of Delivery (mm/dd/yy)
GROCERY ORDER INFORMATION
GROCERY ORDER FORM
Type of bag preferred:
Select Bag Preference
Would you like your items put away for you?
Select Put Away Preference
Yes ($5.00 fee)
Please check the box if you want item substitution
Other specific directions
If you have any questions, please do not hesitate to contact me
Phone 616-520-5019 or Email: email@example.com
I will contact you to confirm the delivery day/time
within 1 hour.
Thank you for your order!