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(541) 928–2221


We Shop 4 U Order Form
Date

Today's Date

Order Time

Time of Order


Customer Information
Name

Please enter your name

Phone

Enter your contact number

Email

Enter your e-mail address


Store Information
Store

Enter the name of the store where you'd like us to shop (If you do not have a preference, then enter N ⁄ P)

Address

Enter the store address

City

Which city?


Shopping List Information

List the items and approximate cost of each

Total

Approximate total?


Drop Off Location Information
Address

Where do we deliver your order?

City

City?


Payment Information

If you haven't paid for your items, we can pay for you as we pick the items up providing you prepay us for your items by calling our dispatcher at 541–928–2221.