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Whole Heart Kitchen Ordering
If you have any questions regarding this form, please reach out to Tabitha Bales at 937-489-8821.
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Name:
*
Your answer
Address:
Your answer
City
Your answer
Phone Number:
*
Your answer
Email
*
Your answer
Weekly Order? (5 Meals? 10 Meals?)
*
Your answer
Sweet Treat Add On?
*
Yes
No
Order Will Be:
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Delivery
Pick Up
What Date Would You Like To Start Receiving Meals? (Meals are ready for Pick Up or Delivery on Wednesdays)
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MM
/
DD
/
YYYY
Card you would like to be Charged Weekly (Must include card number, expiration date, 3 digit code on the back, and the zip code)
*
Your answer
Special Notes
Your answer
Alternative Contact Person and Best Contact Info
Your answer
Please Check Each I Agree Box to Sign Up for Meals
*
I agree that I am signing up for a weekly meal subscription and that I can cancel or skip a week of meals at any point of time. However if I do not cancel before Monday at 6:00 PM the week I would like to cancel I will be charged for that week of meals.
I agree for my card to be charged each Wednesday .
I agree to notify Tabitha Bales at 937-489-8821 before Monday at 6:00PM the week you need to cancel or skip a week of meals. If you do not cancel before then you will be charged for that weeks meals.
I agree to notify Tabitha Bales before Monday at 6:00 PM if I need to change the card on file.
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