Heartland Roots Homestead Bread Order Form

Heartland Roots Homestead Bread Order Form

Select your items, flavors, quantities, and choose your payment method. Pick-up in Brashear or delivery to Kirksville is available on Wednesdays and Fridays.
Note: Pickup and delivery days are Wednesday and Friday of each week. Front porch pick up is located at 206 S. Oak St., Brashear. Delivery is available in Kirksville.

For Wednesday orders, order must be placed by Sunday at 5pm. For Friday orders, order must be placed by Tuesday at 5pm.

***If needing a weekend order or special catering, please reach out via Facebook or Instagram messenger or call/text 660-216-0061.
Your Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date (Choose the date you would like your order ready)

MonthDayYear
Will this be a front porch pick up? (Pick up is at 206 S. Oak St., Brashear)
Will this order need to be delivered? (Delivery is only available in Kirksville)
Delivery Address (If delivery is the chosen option above)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Special instructions. Please include where order should be dropped off. (i.e. front porch, back porch, etc.) If you need to meet in Kirksville please indicate below. I will contact you to identify a time that works for all parties.

Sandwich Bread

Bread includes yeast.

$5.00

Flavor	Quantity	Price
Plain		$5.00

Item subtotal:

Artisan Bread (Savory)

Bread includes yeast.

$5.00

Item subtotal:

Artisan Bread (Sweet)

Bread includes yeast.

$7.00

Flavor	Quantity	Price
Cinnamon & Brown Sugar		$7.00
Chocolate Chip & Cream Cheese		$9.00
Peanut Butter & Chocolate Chip		$9.00

Item subtotal:

Bread Bowl

Please choose bread & dip flavor. Bread bowls include three fruit or vegetable options. Those can be selected below. Bread includes yeast.

$25.00

Bread Flavor	Quantity	Yogurt Flavor	Price
Plain			$25.00
Italian Herb & Cheese			$28.00
Rosemary Garlic			$28.00
Cinnamon & Brown Sugar			$28.00
Jalapeno Cheddar			$30.00
Chocolate Chip & Cream Cheese			$30.00
Peanut Butter & Chocolate Chip			$30.00

Item subtotal:

Total

Fruit/Veggie Options for Bread Bowl Orders (choose up to 3)
Payment Methods

Choose from one of the PayPal options to make your payment.
Should be Empty: