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GROCERY ORDER FORM

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Personal Information
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Your Name * Email Address *
Your Address * Telephone Number *
Fax Number *

Arrival Date

Local Address

Instructions
Delivery    Pickup

Payment Information
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Grocery Categories
Beverages
Breads
Cereals
 Condiments and Sauces
Dairy
Fresh Fruits
 Fresh Vegitables
Health and Beauty
Jams and Spreads
 Liquor
Meat, Poultry, Fish
Pastas and Rice
 Snacks

Beverages
7up 6 pck 
2L 
Apple Juice 1L 
Bottled Water 1.5L 
Coke 6 pck 
2L 
Cranberry Juice 1.14L 
Diet Coke 6 pck 
2L 
Diet Pepsi 6 pck 
2L 
Dr.Pepper 6 pck 
2L 
Fanta 6 pck 
2L 
Ground Coffee 300g
Herbal Tea
Hot Chocolate Mix
Instant Coffee
Mountain Dew 6 pck 
2L 
Orange Juice 1L 
Pepsi 6 pck 
2L 
Sparkling Water 1L 
Sprite 6 pck 
2L 
Tea
Other
Enter a special request. The item cost will be added to your final order total; it will not appear in your total when you submit your order from this order form. 		 

Breads
Bagels (6)
Croissants
English Muffins (6)
French Loaf
Rye Bread
Sliced Wheat
Sliced White
Sourdough Rolls
Other
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Cereals
Alpen
Cheerios
Flavoured Instant Oatmeal
Frosted Flakes
Fruit & Fibre
Granola
Granola Bars (box)
Honey Nut Cheerios
Kids Variety Pack
Nutrigrain Bars (8)
Pancake Mix
Variety Pack
Other
Enter a special request. The item cost will be added to your final order total; it will not appear in your total when you submit your order from this order form. 		 

Condiments and Sauces
Alfredo Sauce Mix
Cooking Oil
Dijon Mustard
Dill Pickles
Guacamole Mix
Hollandaise Sauce Mix
Ketchup
Mayonnaise
Miracle Whip
Mustard
Olive Oil
Olives
Red Wine Vinegar
Relish
Salad Dressing
Steak Sauce
Tabasco
Taco Seasoning
Tomato Pasta Sauce
White Vinegar
Worchestershire
Other
Enter a special request. The item cost will be added to your final order total; it will not appear in your total when you submit your order from this order form. 		 

Dairy
1% Milk 1L
2% Milk 1L
Block Cheddar 227g
Brie 125g
Camembert 125g
Coffee Cream 500g
Cottage Cheese 250g
Cream Cheese (type?)
Eggs (1 dozen)
Feta 250g
Fruit Yogurt 175g
Grated Parmesan 250g
Homo Milk 1L
Margarine 500g
Mozzarella 227g
Plain Yogurt 500g
Process Slices 250g
Salted Butter 250g
Shredded Cheddar 500g
Shredded Mozza 500g
Skim Milk 1L
Sour Cream 500g
Swiss 250g
Whipping Cream
Other
Enter a special request. The item cost will be added to your final order total; it will not appear in your total when you submit your order from this order form. 		 

Fresh Fruits
Bananas
Grapefruit
Green Apples
Green Grapes 250g
Kiwis
Lemons
Limes
Oranges
Pears
Red Apples
Red Grapes 250g
Other
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Fresh Vegitables
Avocado
Caesar Salad Mix
Cucumber
Garlic
Green Onions
Green Peppers
Leaf Lettuce
Mini Carrots 500g
Mixed Bag Salad
Mushrooms 500g
Onions
Potatoes
Red Peppers
Spinach
Tomatoes
Other
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Health and Beauty
Cold Remedies
Conditioner
Disposable Razors
Hair Gel
Hair Spray
Headache Tablets
Nail Polish Remover
Shampoo
Shaving Cream
Toothbrush
Toothpaste
Other
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Jams and Spreads
Creamy Honey
Liquid Honey
Marmalade
Pancake Syrup
Peanut Butter (crunchy)
Peanut Butter (smooth)
Raspberry Jam
Real Canadian Maple Syrup
Strawberry Jam
Other
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Liquor
Beer 6 pck 
case (24) 
Spirits rum 
vodka 
gin 
Wine white 
red 
Other
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Meat, Poultry, Fish
Bacon 250g
BBQ Chicken (Whole, half)
Beef Jerky
Boneless Chicken Breast
Frozen Lasagna 1kg
Ground Beef (lean)
Ground Chicken
Ground Pork
Lamb
New York Strip
Pate 175g
Pork Chops
Salmon (fillet)
Salmon (steak)
Salmon (whole)
Salmon Jerky
Sliced Ham 175g
Sliced Roast Beef 175g
Sliced Smoked Salmon 100g
Sliced Turkey 100g
Snapper Fillets
Tenderloin
Top Sirloin Steak
Other
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Pastas and Rice
Fresh Fettucine
Fresh Tortelinni
Kraft Macaroni & Cheese
Penne
Rice Vermicelli Noodles
Spaghetti
White Rice
Other
Enter a special request. The item cost will be added to your final order total; it will not appear in your total when you submit your order from this order form. 		 

Snacks
Almonds
Cashews
Cheesies
Chip Dip
Chocolate Bars
Crackers
Mixed Nuts
Nacho Chips
Potato Chips
Pretzels
Roasted Peanuts
Salsa Dip
Tortilla Chips
Other
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