Delivery Request
Thank you very much for using Social Distance Delivery! Once you complete this form, we will reach out to you as soon as we've scheduled your delivery. Please allow at least 12 hours for us to process your order.

We are doing our best to complete every delivery as soon as possible with limited resources. If you are a healthy, able-bodied person (UVA graduate student, etc.), please consider shopping for yourself before using our service so that we can focus our attention on the members of the community who need our help the most.
Email *
Is this your first time using our service? *
Full Name *
Delivery Address (please include zip code) *
Phone Number *
Desired Date of Delivery (We do not complete deliveries on Sundays. Delivery date cannot be guaranteed, and same-day delivery is often impossible) *
Where would you like us to shop? (please only select one store to ensure timely delivery) *
List desired groceries and goods below (limit of 25 items) *
**IF POSSIBLE PLEASE SPECIFY ITEM LOCATION, PACKAGE, ETC. THE MORE SPECIFIC YOU ARE, THE QUICKER WE'LL BE ABLE TO DELIVER YOUR ORDER**
Payment Method (please note you can now pay directly on our website using PayPal!) *
Please note that we will ask you to make any checks out to your delivery helper.
Questions or comments?
You can also reach our Charlottesville Regional Director directly at 540-270-6879 with any concerns.
A copy of your responses will be emailed to the address you provided.
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