Market Delivery Order Form

Full Name

First NameLast Name

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Delivery Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Preferred Delivery Date

Date

Hour MinutesAM/PM Option

Fresh Apples (1 lb)

Crisp, locally sourced apples by the pound.

$2.99Quantity

Organic Carrots (1 lb)

Sweet, organic carrots in 1 lb bundles.

$1.79Quantity

Farm Eggs (Dozen)

Free-range farm eggs, one dozen.

$4.50Quantity

Whole Wheat Bread (Loaf)

Freshly baked whole wheat bread.

$3.25Quantity

Milk (1 Gallon)

Whole milk, 1 gallon.

$3.99Quantity

Seasonal Berries (Pint)

Assorted fresh seasonal berries.

$5.75Quantity

Potatoes (5 lb Bag)

Locally grown potatoes, 5 lb bag.

$4.25Quantity

Mixed Greens (Bag)

Fresh salad greens, pre-washed.

$3.99Quantity

Total

Order Notes (optional)

Delivery Instructions (optional)

Preferred Payment Method