Order Request

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Order Request

*We are currently experiences some shortages and delays from our distributors. After you fill out this order request, we will contact you to go over details and availability before the order is completed. If you would like faster service and direct information on current stock and pricing please contact us at (309)829-2621

Email *

Name *

Phone number *

Pick up date

YYYY

When will you pick up your order? *

Between 11am-1pm

Between 1-3pm

Between 3-5pm

Other:

Please Type Your Order, Separate by commas. Be specific as possible including size/quantities and variations (dry or canned beans)

Form of payment (processed in store) *

Charge

Cash

LINK/EBT/Food stamps (Must tell us so we can do tax exempt)

Call you if we're out of something?

Yes

Other:

Clear selection

Any special notes, acceptable substitutions?

Submit

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