Points Program Order Form

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* Please check the inventory list for current items we have in stock.
* Requests must be placed before 5pm Friday to be available the following week for pick-up.
* Requests will be processed in order received.
* Text, called or emailed orders will not be processed.
* Any items found for sale will result in permanent removal from the program.
* An email confirmation will be sent when your items are ready for pick-up.

Name *

Email Address *

Phone Number *

Preferred day & time for pick-up. (Days and times are not guaranteed.)

8:30-9:30

9:30-10:30

10:30-11:30

1:30-2:30

2:30-3:30

Monday

Tuesday

Wednesday

Thursday

Please email a photo of the latest page of your Points register to jcpoints@jonescountyiowa.gov *

I will do this prior to pick-up

Required

I have checked the inventory list before submitting this order. *

Yes

I do not know where to find the inventory list

Required

How to enter item requests:

Enter each item on a new line, with the quantity requested first. For example:
1 deodorant
1 crib mattress
1 diapers size 2

I have read and understood how to enter an item request. *

Yes

Please enter item request below. *

Submit

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