Doorstep Deliveries Order Form

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Please fill out this form in order to receive your groceries at your doorstep. **read instructions below**

- Make sure to use the correct address of the store (links provided)
- Make sure to select the PICK UP from store option as you order online
- Make sure to use OUR phone number: 847-701-4216 as you checkout
- Choose a date and time for pickup
- We ask that you do not order any alcoholic beverages, tobacco products, or cough medicine. We will be unable to pick up your order if you do purchase these items.

Please let us know if you have any questions or concerns at this email: ddeliveries0@gmail.com

Name (First, Last) *

Address (Street, City, State, Zip Code, Apt. Number if Applicable) *

Form of contact: Phone Number *

Do you understand that you MUST put our phone number (847-701-4216) when you checkout? *if you don't, we will be unable to pick up your order *

Yes

Other:

Store to Pick-Up order from (make sure to use THIS specific address!) *

Walmart - 820 S Rand Rd, Lake Zurich, IL 60047 - https://grocery.walmart.com/?adid=1500000000000039636450&veh=wmt

Target - 679 E Dundee Rd, Palatine, IL 60074 - https://www.target.com/c/order-pickup/-/N-ng0a0?Nao=0

Other store: If so, please contact us for information

Time Slot for Pick-Up *

Time

Date for Pick-Up *

YYYY

Please provide any additional information (if necessary)

Terms and Conditions

Please agree to these Terms and Conditions *

I agree

Required

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