Concierge order form

Contact Information
As a Pet Care Professional, I have taken a hit with Covid-19. Providing pet care services to our clients is my livelihood. I have established a temporary concierge service so we can support our community while helping me support my family during this difficult time. If you are high-risk, in isolation or would like help, I am able to pick up your groceries, prescriptions and other essentials for a nominal fee. Just order ahead and we will pick-up and deliver to your front porch.
Best,
Melanie
Name*
First Last
Email*
Phone*
Pick-Up Information
Please select the number of Pick-Up Locations*
The fee per order is $25 for pick-up and delivery to your home. Each additional stop is $10/stop.

Please add pickup location(s) with address*

Please use the + sign on the right of the field to add additional locations

Location	Address	Pickup Notes

Drop-Off Information
Delivery Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Drop-Off Instructions*
Please let us know where you would like us to leave your delivery. We will not enter your home.
Consent
I agree to the delivery details
Delivery Details
- Please ensure your order will be ready during the requested pick-up window.
- Please ensure that we are listed to be able to pick-up your order.
- Orders will be dropped off outside your home.
- We are not responsible for orders that are incorrect.
Total
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name