Order and Pickup Form
Create your order and pick up with appointment.
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Pickup Appointment
Order
Categories:
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Purple T-Shirt
Please enter a short description.
$
17.00
Quantity
1
2
3
4
5
6
7
8
9
10
Sweater
Made of 100% silk.
$
21.00
Sundress
Two color options.
$
25.00
1
Pink
Red
Fruits
Bananas, Oranges, Strawberries, Apples
$
9.00
Veggies
Broccoli, Carrots, Tomatoes
$
8.50
Dairy
Cheese, Milk, Eggs
$
7.00
Super Spray
All surfaces.
$
2.00
Cleaning Kit
All you need for cleaning.
$
17.00
Antibacterial Mop
Antibacterial.
$
7.00
Notes
Submit
Should be Empty: