grocery shopping form by M0m11j


									                                                                Cookie’s Specialty Errand Service
                                                                                         PO box 2
                                                                                 Koloa, Hi. 96756
1. Our rate is $_____ per hour. Additional time billed in 15 minute increments + cost of groceries.
2. Payment is due at time of delivery – cash or check.
3. Rate includes travel time to and from grocery store.
4. Please order 24 hours in advance.
5. Call or Email your shopping list to: Phone
6. Our Email address:

7. Your name:
8. Your address:
9. Your Phone:
10. Best delivery date & time for you:
11. Preferred grocery store:
12. Special instructions:
13. List the items you want. Please include: size or weight, quantity, brand name and description (example: 3
cans 15oz. Kroger garbanzo beans)
14. If any item is not available at your preferred grocery store, I authorize __________________ to buy the item at
another store, and agree to pay for the extra time at the specified rate. Customer initial: ________________

If groceries are delivered to your home while you are away, you agree to provide a key for delivery, and we
can (check your choice):
Leave the key in a secure place.
Retain the key for future deliveries.

We agree to deliver and put away groceries in the kitchen or designated area, exit and secure the residence.
We will not be responsible or liable for any items missing from residence.
I have read, and agree to this Grocery Shopping Agreement.
Customer: ________________________________________________Date: ________________________________________
Errand Service: ________________________________ Date: ______________________________

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