Your Grocery List

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Your Grocery List

Full Name *

Phone Number *

Please re-enter above phone number to ensure correctness.

Address *

Zip Code *

Do you have a preferred grocery store? If so which one?

What groceries do you need? ( please limit to to 12 items ) *

Form of Payment *

How did you hear about Zoomers to Boomers? (Not required if you have already answered this in a previous order)

Acknowledgements *

Zoomers to Boomers is designed to help the senior and immunocompromised members of our community

Zoomers to Boomers asks that you limit your delivery requests to 1 per week

Zoomers to Boomers will donate all tips (not necessary) to those in need in the community

While Zoomers to Boomers takes, and asks that its volunteers take, certain safety precautions in the face of the COVID-19 pandemic, I hereby acknowledge that accepting deliveries during said pandemic carries some risk of exposure, and hereby assume all such risk.

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