Jeremiah’s Cookies | Dessert Order Form

Jeremiah’s Cookies | Dessert Order Form
Customer Information

Please provide your contact information so we can confirm your dessert order and send your remaining balance invoice.
Your Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.

Dessert Selection

Select your homemade desserts, preferred flavors, and quantities. All desserts are family-sized and freshly prepared.
Peach Cobbler - $30

Homemade peach cobbler featuring sweet, juicy peaches, warm cinnamon, and a rich, buttery golden crust. Freshly baked with Southern-style flavor.
Select Your Cobbler Flavor
Quantity
Drunken Cobbler — $45

A rich, Southern-style homemade cobbler featuring sweet, juicy fruit, a buttery golden crust, and warm cinnamon. Infused with liquor for a delicious twist on a classic favorite.

Contains alcohol.
Select Your Cobbler Flavor
Quantity
Banana Pudding — $35

A rich, creamy Southern-style banana pudding made fresh with layers of smooth vanilla pudding, sweet bananas, and delicious cookies. Topped with a generous layer of crushed cookies for the perfect finishing touch.
Banana Pudding Flavor
Quantity
Homemade Pound Cake — $50

A rich, moist, buttery Southern-style pound cake made from scratch with quality ingredients and baked to golden perfection. Each cake is full of homemade flavor, with a tender texture and just the right amount of sweetness.
Available Flavors
Quantity

Special Instructions & Allergy Information
Please provide any special requests, food allergies, or additional details about your order. If ordering multiple desserts in different flavors, specify the quantity of each flavor.

Example: 2 Peach Cobblers and 1 Blackberry Cobbler.

All special requests are subject to approval.
Special Instructions or Flavor Quantities
Do you have any food allergies we should be aware of?
Do you understand that all Thanksgiving orders must be picked up on Wednesday, November 25, 2026?

Payment & Deposit

Please review your dessert order and the payment requirements below. A 50% deposit is required to secure your preorder. Your remaining balance will be sent by invoice and must be paid in full before pickup
Preferred Deposit Payment Method
Name on Payment Account
Payment Confirmation
Order Total
Upload Your Payment Confirmation Screenshot - 50% Due

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Order Pickup Scheduling

Please select your preferred pickup time. Pickup details will be provided with your order confirmation.
Appointment
Who Will Be Picking Up Your Order?
Authorized Pickup Person's Full Name
Authorized Pickup Person's Number
Policy Acknowledgment: I understand that all Thanksgiving orders must be paid in full before pickup. I agree to arrive during my scheduled pickup time and notify Jeremiah's Cookies in advance if I need to make changes.
The exact pickup address will be provided on your final invoice. Please review your invoice carefully and arrive during your scheduled pickup window.
Dessert Order Agreement & Signature

Please review and acknowledge the following terms before submitting your order.
By signing below, I acknowledge and agree that:

A 50% deposit is required to secure my order.
My order is not confirmed until my deposit has been received and verified.
The remaining balance will be invoiced and must be paid in full before pickup.
I agree to arrive during my scheduled pickup window.
The exact pickup address will be provided on my final invoice.
All desserts are freshly prepared to order.
Any changes to my order or pickup time must be approved by Jeremiah’s Cookies in advance.
I Have Read and Agree to the Dessert Order Terms
By signing, I confirm that the information provided is accurate and that I understand and agree to Jeremiah’s Cookies' ordering, payment, and pickup policies.
Should be Empty:

Customer Information