Groceries to Go Order Form
Orders are due by 1 pm on Monday for Thursday delivery. If your order is placed after 1 pm on Monday, it will be held for next Thursday delivery.
*
First Name
Last Name
My Products
Categories:
All
All
Refrigerated
Fresh Produce
Fruit
Vegetables
Soup/Mac N' Cheese
Condiments
Canned Foods
Beverages
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Refrigerated
IF AVAILABLE - MILK
$
Free
Quantity
1
If AVAILABLE - EGGS
$
Free
Quantity
1
Fresh Produce
IF AVAILABLE - FRESH FRUIT
$
Free
Quantity
1
IF AVAILABLE - FRESH VEGETABLES
$
Free
Quantity
1
Fruit
Dole Mixed Fruit Cup 7 oz
$
Free
Quantity
1
2
Vegetables
Mixed Green Beans 14.5 oz
No salt added
$
Free
Quantity
1
2
Sweet Peas 15 oz
$
Free
Quantity
1
Corn 15.25 oz
$
Free
Quantity
1
Soup/Mac N' Cheese
Macaroni and Cheese 7.25 oz
$
Free
Quantity
1
2
Chicken Noodle Soup 10.5 oz
$
Free
Quantity
1
Vegetable Soup 10.5 oz
$
Free
Quantity
1
Condiments
Creamy Peanut Butter 16 oz
$
Free
Quantity
1
Canned Foods
Diced Tomatoes 14.5 oz
$
Free
Quantity
1
Beverages
Prairie Farms Chocolate Milk
Manufacturer date extension: 11-1-2025.
$
Free
Quantity
1
2
Apple Juice Box 6.75 oz
$
Free
Quantity
1
2
Ghost Hydration Drink - Lemon Lime 16.9 oz
$
Free
Quantity
1
Ka'Chava Superfood Protein Powder (Vanilla) 31.75 oz
$
Free
Quantity
1
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Date of Birth
*
Please list ages of all household members
*
Estimated monthly household income
*
Why do you need your food delivered?
*
Health too poor to go to food pantries or Community Kitchen
No transportation to food pantries or Community Kitchen
Food pantries/Community Kitchen aren't open when I have transportation
Other
Is anyone in the home a veteran or spouse of a veteran?
*
Yes
No
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