Fire Island Order Form

FIRE ISLAND ORDERS

To help expedite your order, please be as descriptive as possible with brands, flavors, varieties, and quantities.
ORDER FULFILLMENT

Order fulfillment is 2-3 days. Please call us at 631-736-6181 to inquire about lead time due to scheduling with the freight ferry. All Fire Island orders are subject to additional fees for special packing and the freight ferry cost. Please call to inquire.
Order Placed On:

MonthDayYear
DateHourMinutesAM/PM Option
Customer Name*

First NameLast Name
Delivering to Community*
Billing / Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone*
Mobile Phone*
How Did You Hear About Our Fire Island Shopping Service?
Email*
example@example.com
Is This Order for Pickup or Delivery?*

Pickup at StoreDelivery on Freight Ferry
Request Pickup Time at Store*
Requested Pickup/Delivery Date*

MonthDayYear
Date
Requested Pickup Time*

:HourMinutesAM/PM Option
Please Note the Freight Ferries Do Not Deliver on Sundays. Please Plan Accordingly. Thank you.
When we have the order all set, we will call you to confirm and process the payment at that time over the phone.

PLEASE DO NOT ENTER CREDIT CARD INFORMATION ON THIS FORM.

PRODUCE DEPT.
Please list each item and quantity desired.
DELI, PREPARED FOODS, CHEESE, FRESH PASTA
Please list each item and quantity desired.
BAKERY DEPT.
Please list each item and quantity desired.
SEAFOOD DEPT.
Please list each item and quantity desired.
MEAT DEPT.
Please list each item and quantity desired.
FROZEN DEPT.
Please list each item and quantity desired.
DAIRY DEPT.
Please list each item and quantity desired.

To help expedite your order, please be as descriptive as possible with brands, flavors, varieties, and quantities.
GROCERY DEPT.
AISLE 1

Peanut Butter, Jelly, Sliced Bread, Hamburger & Hot Dog Buns, Cookies, Crackers, Popping Corn, Marshmallows
Please list each item and quantity desired.
AISLE 2

Coffee, Tea, Cocoa, Baking Needs, Flour, Salt, Sugar, Cake Mix, Pancake Mix, Cold Cereal, Hot Cereal, Granola, Protein Bars
Please list each item and quantity desired.
AISLE 3

Juice, Bottled Tea, Powdered Drink Mixes, Canned Fruit, Dried Fruit, Gluten Free Items, Candy, Chocolate Bars
Please list each item and quantity desired.
AISLE 4

Salad Dressing, Ketchup, Mustard, Mayonnaise, Condiments, Marinades, Pickles, Olives, Vinegar, Oil, Pasta, Pasta Sauce, Canned Tomatoes
Please list each item and quantity desired.
AISLE 5

Tuna Fish, Seafood, Prepared Foods, Macaroni & Cheese,Soups, Stocks, Gravy, Mashed Potatoes, Canned Vegetables, Goya Products, Mexican Foods, Chinese Foods, Rice, Spices & Seasonings
Please list each item and quantity desired.
AISLE 6

Laundry Detergents, Household Cleansers, Air Freshner, Dish Detergent, Sponges & Steel Wool, Trash Bags, Food Storage Bags, Hand Soap, Health & Beauty Care, Pet Foods
Please list each item and quantity desired.
AISLE 7

Paper Products, Paper Towels, Napkins, Tissues, Bath Tissue, Plates, Cups, Utensils, Brooms, Mops, Light Bulbs, Batteries, Soda, Seltzer, Bottled Water, Drinks & Flavored Water, Drink Mixers
Please list each item and quantity desired.
AISLE 8

Beer (Domestic, Imports, Crafts), Potato Chips, Pretzels,Tortilla Chips, Salsa
Please list each item and quantity desired.
AISLE 9

Baby Care, Feminine Hygiene Products, Adult Incontinence Products, Protein Drinks, Nutritional Supplements, Vitamins, Cold/Pain Medicine
Please list each item and quantity desired.
AISLE 10

Charcoal, Lighter Fluid, Fire Logs, Rock Salt
Please list each item and quantity desired.

Any special instructions?
DO NOT include any financial information in the email, we will ask for that over the phone. This is to keep your personal data as safe as possible. We are not responsible for any financial data entered here.
If you are picking up on the way to the ferry, just give us a ring at 631-736-6181 and we can bring your groceries out to your car!

If your order was submitted correctly, you should receive a confirmation email.

Should be Empty:

FIRE ISLAND ORDERS

ORDER FULFILLMENT

PRODUCE DEPT.

DELI, PREPARED FOODS, CHEESE, FRESH PASTA

BAKERY DEPT.

SEAFOOD DEPT.

MEAT DEPT.

FROZEN DEPT.

DAIRY DEPT.

GROCERY DEPT.

AISLE 1

AISLE 2

AISLE 3

AISLE 4

AISLE 5

AISLE 6

AISLE 7

AISLE 8

AISLE 9

AISLE 10