SBFM Curbside Order Form 2021
South Bend Farmer's Market Curbside Order Form 2021
* Required
Email address
*
Your email
Customer Name ( First and Last Name) please
*
Your answer
Make and color of vehicle picking up groceries
*
Your answer
Phone Number - so we can text you with questions or let you know your order is ready
*
Your answer
Date order is placed**** Please note: If you place your order after 2:30 on Tuesday - please pick up on Thursday, after 2:30 on Thursday - please pick up on Saturday; after 2:30 on Saturday - please pick up on the following Tuesday. THANK YOU
*
MM
/
DD
/
YYYY
Date I would like to pick up my curbside order
*
MM
/
DD
/
YYYY
I would like to pick up my SBFM Curbside order between..... Pick-up your curbside order at DOOR C at the time and date requested.
*
8:00 - 8:30 AM
8:30 - 9:00 AM
9:00 - 9:30 AM
9:30 - 10:00 AM
10:00 - 10:30 AM
10:30 - 11:00 AM
11:00 - 11:30 AM
11:30 AM - 12:00 PM
12:00 - 12:30 PM
12:30 PM - 1:00 PM
1:00 PM - 1:30 PM
1:30 PM - 2:00 PM
After 2:00 PM but before 2:45 PM (Last pick-up time is 2:45 PM)
Text me with the amount owed when my order is ready
*
YES
NO
How will you be paying for your curbside groceries and service. Please note a $3.00 service fee is added to your total to cover bags and other costs.
Cash
Check - please make check out to South Bend Farmer's Market
Clear selection
First Item
*
Your answer
Quantity of first item
*
Your answer
Packaging of first item
*
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Preferred vendor for first item. ** if left blank, the Market shopper will choose.
Your answer
Second Item
Your answer
Quantity of second item
Your answer
Packaging of second item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for second item. ** if left blank, the Market shopper will choose.
Your answer
Third Item
Your answer
Quantity of third item
Your answer
Packaging of third item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for third item. ** if left blank, the Market shopper will choose.
Your answer
Fourth Item
Your answer
Quantity of fourth item
Your answer
Packaging of fourth item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for fourth item. ** if left blank, the Market shopper will choose.
Your answer
Fifth Item
Your answer
Quantity of fifth item
Your answer
Packaging of fifth item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for fifth item. ** if left blank, the Market shopper will choose.
Your answer
Sixth Item
Your answer
Quantity of sixth item
Your answer
Packaging of sixth item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for sixth item. ** if left blank, the Market shopper will choose.
Your answer
Seventh Item
Your answer
Quantity of seventh item
Your answer
Packaging of seventh item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for seventh item. ** if left blank, the Market shopper will choose.
Your answer
Eighth Item
Your answer
Quantity of eighth item
Your answer
Packaging of eighth item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for eighth item. ** if left blank, the Market shopper will choose.
Your answer
Ninth Item
Your answer
Quantity of ninth item
Your answer
Packaging of ninth item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for ninth item. ** if left blank, the Market shopper will choose.
Your answer
Tenth Item
Your answer
Quantity of tenth item
Your answer
Packaging of tenth item
bag (varied weight if applicable)
small basket (grape tomatoes, berries)
bunch (flowers, green onions)
dozen (eggs, (muffins, rolls, 12 of this item))
each (individual item count)
gallon (milk, apple cider, syrup)
half-bushel (apples, peaches)
half-gallon (milk, apple cider, syrup)
head (lettuce, cauliflower, cabbage)
loaf (bread)
ounce
pint
pound
quart
Other:
Clear selection
Preferred vendor for tenth item. ** if left blank, the Market shopper will choose.
Your answer
I need other items from the South Bend Farmer's Market - include as much information as possible, please
Your answer
Additional information, note and/or comment
Your answer
A copy of your responses will be emailed to the address you provided.
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