First Name:
Last Name:
Email Address:
Street Address:
City, State, Zip:
Phone Number:
Preferred Grocery Store: No Preference Bilo Earth Fare Food Lion Fresh Market Kroger Publix Wal-Mart
Preferred Delivery Time: Select Time 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM * If there is a conflict with your preferred delivery time we will call you to determine the best delivery time.
Payment Method: Cash Credit / Debit
Were you referred by anyone?: Name:
Directions for placing your order:
1. Enter your grocery list in the box below. Include quantity and brand preferences (if any) for each of your items. You may also choose to add notes or comments to help us better serve you.
2. Click Submit
3. After you submit your order, a member of our staff will call or email you to review and confirm your order.
Please confirm my order by phone
or
Please confirm my order by email
If you prefer to give us your order over the phone, please do not hesitate to call us at (803) 624-2243.
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