Welcome

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Terms & Conditions* This field is required.
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Service Area Check Please enter your delivery zip code
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Sorry, we don't currently serve your area at this time. Keep checking back as we expand our operation!
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Delivery Date Preference* This field is required.Appointments are subject to availability. We may contact you to confirm, cancel, or change appointments at our discretion
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Name* This field is required.
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Address* This field is required. Please provide your full delivery address
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Phone Number* This field is required.
Please enter a valid phone number.
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Email* This field is required.
example@example.com
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Estimated Item Count* This field is required. How many items do you anticipate ordering?
Please Select
Please Select
1-20 > Basic Tier - $45
21-30> Standard Tier - $65
31-40> Mega Tier - $85
41+>Bulk Tier - Quoted
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Preferred Add-OnsAdd-ons subject to availability. Will be added to final invoice
Grocery put away - $5
Extra Stop (1-5 items within 1 mi of order location) - $15
Pharmacy Pickup (same store / building or within 1 mi of order location) - $10
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How would you like to submit your order?
Type each item in to form
Submit photo of item list
Call , text, or email the item list
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Upload Photo Of Item List* This field is required. Upload a photo of your grocery shopping list
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Configurable list* This field is required.
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Please send your order list within 24 hours of submitting this form.

📱 Call/Text: (717) 555-1234
📧 Email: orders@pantrycartco.com

When sending your list, please include:

Your full name and delivery address

Estimated number of items

Any special instructions (brands, substitutions, etc.)

✅ We will confirm your order, provide an estimated total, and send you an invoice before shopping.
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