à la Car Durango Delivery Form Name:________________________________________________ Phone: _________________________________ Arrival Date: ___________________________________________ (Minimum 24 hour notice required) Requested Arrival Time: ___________________ (à la Car will call to confirm) Please complete the grocery form below, specifying the item (if not already listed), quantity, desired brand, description if needed (size, flavor, etc.) o If brand specific, please note if substitutions are allowed YES NO If substitutions are not allowed, and brand, size, flavor, etc. is not available, no item will be purchased • Additional space is available at end of the form to detail other items not already listed • You pay market prices, plus a delivery fee of 20% of the grocery bill ($20.00 minimum delivery fee), with a 15% automatic gratuity for your delivery driver. • Produce – Fruits: Produce – Vegetables: Deli: Include Qty, Brand &/or Description Include Qty, Brand &/or Description Ham_______________________ Turkey______________________ Salami_______________________ Roast Beef___________________ Other_______________________ Cheddar_____________________ American____________________ Provolone____________________ Swiss________________________ Muenster____________________ Other_______________________ ____________________________ ____________________________ (Items may be seasonal) Apple_______________________ Apricot______________________ Banana______________________ Blackberry___________________ Blueberry____________________ Cantaloupe___________________ Cherry_______________________ Cranberry____________________ Grape _______________________ Grapefruit___________________ Honeydew___________________ Kiwi ________________________ Lemon______________________ Lime________________________ Mango______________________ Melon ______________________ Nectarine____________________ Orange ______________________ Peach_______________________ Pear ________________________ Plum________________________ Pineapple____________________ Pomegranate_________________ Raspberry____________________ Strawberry___________________ Watermelon _________________ Other_______________________ (Items may be seasonal) Artichoke_________________ Asparagus_________________ Avocado__________________ Bell Peppers_______________ Broccoli__________________ Cabbage__________________ Carrots___________________ Carrots (baby)_____________ Celery____________________ Corn on the cob____________ Cucumber ________________ Garlic Bulbs_______________ Kale_____________________ Lettuce (Iceberg)___________ Lettuce (Romaine)__________ Lettuce (Green Leaf)________ Lettuce (Other)____________ Mushrooms_______________ Onions___________________ Potatoes__________________ Salad Mix_________________ Spinach___________________ Squash___________________ Sugar Snap Peas____________ Tomatoes_________________ Zucchini__________________ Other____________________ Include Qty, Brand &/or Description Meats: Include Qty, Brand &/or Description Steaks_______________________ Bacon_______________________ Chicken______________________ Fish_________________________ Ground Beef _________________ Ground Turkey________________ Hot Dogs ____________________ Pork Chops __________________ Sausage_____________________ Sausage Links ________________ Other_______________________ ____________________________ Cheeses: (Specify sliced or shredded) Include Qty, Brand &/or Description American ____________________ Blue Cheese Crumbles__________ Brie_________________________ Cheddar_____________________ Cheddar (Sharp) ______________ Feta________________________ Goat Cheese__________________ Havarti______________________ Monterey Jack ________________ Mozzarella___________________ Mozzarella (Fresh)_____________ Munster_____________________ Pepper Jack __________________ Swiss _______________________ Sandwich Singles______________ Other _______________________ ____________________________ ____________________________ Dairy: Include Qty, Brand &/or Description Butter_______________________ Coffee Creamer_______________ Cottage Cheese_______________ Eggs________________________ Half & Half___________________ Margarine___________________ Milk (Almond)________________ Milk (Soy)____________________ Milk (Skim)___________________ Milk (2%)____________________ Milk (Whole)_________________ Milk (Organic)________________ Ricotta Cheese_______________ Sour Cream__________________ Yogurt______________________ Yogurt (Greek)________________ Other_______________________ ____________________________ ____________________________ ____________________________ Bread: Snacks: Include Qty, Brand &/or Description Include Qty, Brand &/or Description Bagels_______________________ English Muffins_______________ French Bread_________________ Hamburger Buns______________ Hot Dog Buns_________________ Italian Bread__________________ Rye Bread____________________ Sourdough Bread______________ Tortillas_____________________ Whole Wheat Bread___________ Other ______________________ ____________________________ ____________________________ Breakfast: Include Qty, Brand &/or Description Cereal_______________________ Coffee (Reg)__________________ Coffee (Decaf)________________ Coffee (Filters)________________ Granola______________________ Hot Tea______________________ Pancake Mix__________________ Oatmeal_____________________ Syrup_______________________ Other_______________________ ____________________________ ____________________________ Pasta: Include Qty, Brand &/or Description Angel Hair____________________ Linguine_____________________ Macaroni Elbows______________ Mac & Cheese________________ Parmesan Cheese______________ Penne_______________________ Rice_________________________ Rigatoni_____________________ Spaghetti____________________ Tomato Sauce________________ Other_______________________ ____________________________ ____________________________ Chips (Tortilla)________________ Chips (Potato)________________ Chip Dip_____________________ Cookies______________________ Crackers_____________________ Energy Bars__________________ Granola Bars__________________ Honey_______________________ Humus______________________ Nuts________________________ Peanut Butter_________________ Popcorn_____________________ Pretzels______________________ Salsa________________________ Trail Mix_____________________ Other_______________________ ____________________________ ____________________________ Canned Goods: Include Qty, Brand &/or Description Beans_______________________ Canned Fruit__________________ Canned Tomatoes_____________ Canned Vegetables____________ Chili________________________ Soup________________________ Tuna________________________ Other_______________________ ____________________________ ____________________________ Cooking: Include Qty, Brand &/or Description Cake Mix_____________________ Flour________________________ Garlic Salt____________________ Gravy Mixes__________________ Marshmallows________________ Olive Oil_____________________ Spices_______________________ Sugar_______________________ Other_______________________ ____________________________ ____________________________ Frozen Foods: Drinks & Juices: Alcohol: Include Qty, Brand &/or Description Include Qty, Brand &/or Description Include Qty, Brand &/or Description Appetizers___________________ Burritos_____________________ Fish________________________ French Fries__________________ Frozen Dinners________________ Ice Cream____________________ Pizza________________________ Popsicles ____________________ Tator Tots____________________ Vegetables___________________ Waffles______________________ Other_______________________ ____________________________ ____________________________ Apple Juice___________________ Bottled Water________________ Club Soda____________________ Cranberry Juice_______________ Gatorade____________________ Grape Juice___________________ Juice Boxes___________________ Orange Juice__________________ Soda________________________ Tonic________________________ Other_______________________ ____________________________ ____________________________ Condiments: Include Qty, Brand &/or Description Include Qty, Brand &/or Description BBQ Sauce___________________ Ketchup_____________________ Mayo_______________________ Mustard_____________________ Olives_______________________ Pickles______________________ Pepperoncini_________________ Salad Dressing________________ Steak Sauce__________________ Vinegar______________________ Other_______________________ ____________________________ ____________________________ Personal Supplies: Aspirin______________________ Bar Soap_____________________ Body Wash___________________ Deodorants__________________ Razor _______________________ Shampoo____________________ Suntan Lotion_________________ Toothbrush___________________ Toothpaste___________________ Vitamins_____________________ Other_______________________ ____________________________ ____________________________ Beer________________________ Liquor_______________________ Wine________________________ Other_______________________ ____________________________ ____________________________ Other:_______________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________
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