Request a Free Grocery Delivery
Here is the form to request a grocery delivery. We will usually fulfill your order within 1-2 days. If you would like to send us pictures of the items, do so at
or 971-347-7778. Tips are optional. Thank You!
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Phone Number? (cell preferred, please specify if it's a landline)
What is your grocery list? (including the store). Please be as detailed as you can, and if possible, separate each item with a carriage return (a new line)
Do You Have a Preference for the Date? (EXAMPLE: I would like the delivery done BY________ or I would like the delivery done ON__________
How did you hear about us?
What is your birthday? (optional)
Have you or your family tested positive for COVID-19?
Acknowledgement: PDX Concierge is volunteer-based service and intends to help the community. We hold your private information in high regard and will maintain confidentiality. We are not legally liable for any spoiled foods, incorrect items, or similar concerns and have the permission to provide our volunteers with your personal information to deliver groceries. If there are incorrect items, we will try to get a refund. We also expect you to comply with local and CDC guidelines when receiving delivery at
A copy of your responses will be emailed to the address you provided.
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