Delivery Program Registration

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Grocery Delivery is available for those 60+ who find it difficult or unsafe to navigate our local grocery stores. Simply set up a store charge account with Zup’s and our friendly volunteers will deliver your groceries right to your home. Groceries are ordered Monday between 1 and 4 pm and delivered on Wednesdays between noon and 4 pm.

Name *

Gender *

Female

Male

Birthdate *

YYYY

Street Address *

City *

Zip Code *

County *

St. Louis

Lake

Phone Number *

Emergency Contact: Name, Relation, Phone Number *

Additional Personal Information *

Hearing Impaired

Visually Impaired

Physically Impaired

Currently Sick or Otherwise Compromised

None of the Above

Required

Delivery Information

Call Ahead

Ring Door Bell

Knock

Leave Items at Front Door

Leave Items at Back Door

Leave Items on / in Porch

Grocery Store (preferred)

Zups

Convenience Store

Dollar General

Has Payment Account Set-Up

ANY ADDITIONAL INFORMATION

Submit

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