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FRFC (Portola) Order Request
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Email
*
Your email
Customer Information
Please fill out the information below.
Please select which location you are picking your groceries up from?
*
FRFC Portola, Ca
QNF Quincy, Ca
Name
*
Your answer
Today's Date
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MM
/
DD
/
YYYY
Phone Number
*
Your answer
If you are a member please provide member number. * if you are not a member type n/a
*
Your answer
Vehicle Color Make and Model
*
Your answer
Order Details
Please list the name of the item and quantity you would like to order. For orders greater than 20 items please contact the store.
Item #1
Your answer
Item #2
Your answer
Item #3
Your answer
Item #4
Your answer
Item #5
Your answer
Item #6
Your answer
Item #7
Your answer
Item #8
Your answer
Item #9
Your answer
Item #10
Your answer
A copy of your responses will be emailed to the address you provided.
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