Veggie Box Order Form
Hello, please fill out the form below to place an order for a veggie box. The boxes will likely include what's listed below, but substitutions are possible.

Orders received by 12PM on Tuesday, Wednesday or Thursday will be ready for pickup on the following day. We will give you a call to confirm your order the afternoon before your selected pickup day.

We are committed to providing locally grown produce to people in Lowell. If you're interested in signing up for a weekly veggie box, we can work with you on payment options.

Thank you!
Email address *
Name: *
Phone Number: *
Are you currently experiencing a food access emergency? *
If you do not have enough food to provide for yourself and your dependents and do not currently have the means to pay for it, please select yes below and we will work with you to get access to food.
Do you require delivery? *
We are offering extremely limited delivery services for those who are unable to leave their homes due to quarantine procedures, chronic illness or other complications which increase the risks of contracting or spreading the COVID-19 virus. Deliveries will be completed on Thursday afternoon between 1 and 3 pm.
Address (Lowell deliveries only)
Payment Method: *
Please select your preferred payment method. Unfortunately we are unable to accept cash at this time
Pick Up Day: *
Select your box:
Boxes will likely include what's listed below but substitutions are possible.
Clear selection
Are you interested in signing up for a weekly box at a discounted rate of $20 for a large box or $10 for a small box?
We'll distribute boxes through November 7th and are happy to work with you on payment options.
Clear selection
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Mill City Grows. Report Abuse