Williams Delivery Xpress Grocery Order Form
****Warning**** this was originally made for the PDX Market and prices are different. BLM Market, you can us this form I will be updating it soon. When putting together your order, I hope that you understand that due to covid19 some items are limited or out of stock, they will not always have all the requested items. I can go to another store to find all your items also, if I go to three stores for you there will be a $5.00 charge added on for the third store. Also for your convenience, I have a section at the bottom where you can take a picture or upload your shopping list to this form.
Order Submitted Date & Time*
Month Day Year
Date
Hour Minutes AM/PM Option

Personal Information
Customer Name & Delivery Address*
Email*
example@example.com
What Type Of Order?*
Shop & Deliver Pick Up Only Contactless Delivery Other
We have broken up our form into the different departments to make It easier for ordering and shopping. We ask that make sure you note how many of each item you would like.
The space to the far right is for an alternative just in case the store out of the item you requested. If no alternative is listed we will pick the best replacement, then communicate that with you. If you want no replacement please put none in the alternative space.
If any discounts apply, it will be applied when we check out and send total to you. More info at the info of page.
When we have the order all set, we will text you and let you know we are on the way with your order.
Store Name*
If you have a specific store you want me to shop at then list location here too.
If you are a rewards member, enter your member number below.
If you don't know your number, I will use mine to get you the best saving possible.

Produce Department
What would you like from the produce department?
Please note: please be as specific as possible when listing your vegetables and/or fruits
Please list each item, size, and quantity desired

Grocery Departmemt
What would you like from the grocery department?
This includes chips, crackers, canned goods, chocolate, drinks, packaged baking supplies, seasoning, pasta, soups, etc.
Please list each item, size, and quantity desired

Cooler/ Freezer
What would like from the cooler/freezer department?
This includes cheese, drinks, frozen veggies, frozen fruits, pizza, gluten-free breads, ice cream, etc.
Please list each item, size, and quantity desired

Bulk Department
What would you like out of the bulk department?
This includes bulk spices, grains, teas, granolas, beans, rice, & baking supplies.
Please list each item, size, and quantity desired

Wellness Department
What would you like from the health and wellness department?
This includes beauty supplies, supplements, and CBD products.
Please list each item, size, and quantity desired

Household Department
What would you like from the household department?
This includes paper goods, cleaning supplies and personal care products.
Please list each item, size, and quantity desired

21 & Up
What would you like from the beer and wine department?
PLEASE NOTE: you will need to provide valid identification proving that you are 21+ years of age or older to purchase these items.
Please list each item, size, and quantity desired

Special Note Section
Any special instructions
DO NOT: Include any financial information in this area. This is to keep your data as safe as possible. We are not responsible for any financial data.

Schedule your order
What day & time do you want your
groceries shopped and delivered?

If the day and time slot is not available just message me, and we will get a day and time that's best for both of us.
When would you like your groceries delivered?*
Payment I have a few different ways to pay, you can pay in person with any debit or credit card (Portland area only) I also have Venmo, Paypal, and square. After I review your order I will send you a message about payment and if I need you to prepay. Since this is off the dumpling app I can't always cover the orders.
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USD Payment link PayPal.me/greg61704

Williams Delivery Xpress Grocery Order Form