Seniors Form for Grocery Delivery
What is your name?
What is your address (including apartment number if you live in one)?
What is your phone number?
What groceries do you need?
Do you have any preferences or requirements (e.g. organic/allergies/preferred store)?
When do you need this by?
When are you available to receive the delivery (please provide specific times/dates)?
Please type your signature below.
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