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Shopping List


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Please be as specific as possible for every item. Please include Quantity, Size, Brand and Description (e.g., 1 gallon Borden 2% milk). Note: If you need more room, you can add more than one item per line. For example: (1) 5 lb. bag of potatoes, (5) red delicious apples, (3) ripe tomatoes

If your desired item is not available, would you like us to replace it with a different brand or size?

Fast Food

Whopper, Filet-O-Fish, Big Mac

Fast Food

Floral

Flowers, Greeting Cards, Balloons

Floral

Bakery

Cakes, Cookies, French Bread.

Bakery

Deli Counter

Sliced Meats and Cheeses.

Deli

Produce

Fresh Fruits and Veggies.

Produce

Fresh Meat

Beef, Chicken, Fish, Pork.

Fresh Meat

Packaged Meat/Cheese

Lunch Meat, Hot Dogs, Cheese Slices.

Packaged

Dairy

Milk, Eggs, Butter, Yogurt.

Dairy

Dry Packaged Goods

Bread, Cereal, Chips, Coffee, Pasta.

Dry

Condiments

Ketchup, Mustard, Mayo, Hot Sauce.

Condiments

Canned Items

Soup, Veggies, Fruit, Tomato Sauce.

Canned

Drinks

Soda, Bottled Water, Wine/Beer.

Drinks

Paper Products

Toilet Paper, Paper Towels, Paper Plates.

Paper

Household

Cleaners, Laundry, Dishwasher.

Household

Pet Food

Dog/Cat Food, Treats, Supplies.

Pets

Hygiene/Cosmetics

Shampoo, Soap, Deodorant, Toothpaste.

Hygiene

Frozen Foods

TV Dinners, Veggies, Pizza, Ice Cream.

Frozen Foods

Pharmacy

Allergy, Pain Relief, Bandages.

Pharmacy

Other

Miscellaneous

Other

Contact Information

Note: If you are ordering for someone at a different address, please enter their contact information in the special instructions field on the bottom of this form

Name F
Name L
Phone:
Email:
Delivery
Address 1:
Address 2:
City:
State:
ZIP:
Delivery Time:
Delivery Date:
Preferred Store:
Reward Card#:
Promo Code#:

Special Instructions
 

 

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