BLACK GLOVE DELIVERY
Professional • Protected • Fresh Your List. Our Gloves. Your Door.
Customer Information
Full Name
Phone
Format: (000) 000-0000.
Email
example@example.com
Delivery Address
City / State / ZIP
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Your Grocery List
Add as many grocery items as you need. Include brand, size, quantity, and special instructions.
Grocery Item 1
Item
Brand / Preference
Size
Quantity
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Special Instructions
+ Add Another Item
Choose Your 2-Hour Delivery Window
Select the delivery window that works best for you.
8:00 AM - 10:00 AM
10:00 AM – 12:00 PM
12:00 PM - 2:00 PM
2:00 PM - 4:00 PM
4:00 PM - 6:00 PM
6:00 PM - 8:00 PM
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Substitutions
Substitutions options
Choose closest comparable item
Contact me before substituting
Do not substitute
Maximum Substitution Price
Grocery Budget
Fresh & Special Preferences
Produce Preference
Produce / Ripeness Requests
Meat / Seafood Preferences
Refrigerated / Frozen Requests
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Grocery Put-Away Service
Grocery Put-Away Service Options
Yes - put my groceries away
No - delivery only
Where should items be placed? (optional)
Delivery Preferences
Delivery Preferences Options
Text me when you're on the way
Text / call when you arrive
Leave at door if unavailable
Additional Delivery Instructions
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Customer Authorization
I authorize Black Glove Delivery to purchase the requested groceries on my behalf. If I selected substitutions, I authorize comparable substitutions within my stated limits.
I agree to the authorization above
Customer Signature / Name
Submit Order Request
Black Glove Delivery • 615-379-8111 • order@blackglovedelivery.co Your List. Our Gloves. Your Door.
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