Grocery Order Form Name First Last PhoneMember Number Date you wish to pick up your order MM slash DD slash YYYY Time you wish to pick up your order : Hours Minutes AM PM AM/PM MeatsGround Beef 81/19 Quantity Price: $3.99 Quantity Price per lbAngus Ground Beef Quantity Price: $6.99 Quantity Price per lb6 oz Certified Angus Beef Tenderloin Quantity Price: $12.00 Quantity Price per each16 oz Certified Angus Beef Ribeye Quantity Price: $18.00 Quantity Price per eachSliced Bacon Quantity Price: $4.99 Quantity Price per lbBreakfast Sausage Patty Quantity Price: $4.99 Quantity Price per lbItalian Sausage Quantity Price: $4.25 Quantity Price per lbHot Dogs 6/1 Quantity Price: $3.75 Quantity Price per lbEggs Quantity Price: $0.35 Quantity Price per eachChicken Breast Filets Quantity Price: $4.25 Quantity Price per lbCenter Cut Pork Loin Chops Quantity Price: $3.59 Quantity Price per lbDairySliced American Quantity Price: $3.99 Quantity Price per lbSliced Cheddar Quantity Price: $4.50 Quantity Price per lbShredded Cheddar Quantity Price: $5.50 Quantity Price per lbShredded Mozzarella Quantity Price: $4.10 Quantity Price per lbMilk Quantity Price: $4.50 Quantity Price per gallonProduceIQF Green Beans Quantity Price: $3.34 Quantity Price per lbBroccoli Quantity Price: $2.49 Quantity Price per lbZuchinni Quantity Price: $1.99 Quantity Price per lbAsparagus Quantity Price: $4.50 Quantity Price per lbTomatoes Quantity Price: $0.75 Quantity Price per lbBaking Potatoes Quantity Price: $0.99 Quantity Price per lbOnions Quantity Price: $0.99 Quantity Price per lbLimes Quantity Price: $0.50 Quantity Price per lb English Cucumber Quantity Price: $2.00 Quantity Price per eachLemons Quantity Price: $0.50 Quantity Price per eachOranges Quantity Price: $0.99 Quantity Price per eachBananas Quantity Price: $0.79 Quantity Price per lbOther FoodsFrench Fries Quantity Price: $2.00 Quantity Price per lbSpaghetti Noodles Quantity Price: $1.50 Quantity Price per lbPenne Pasta Quantity Price: $1.99 Quantity Price per lbRigatoni Quantity Price: $1.99 Quantity Price per lbFlour Quantity Price: $0.60 Quantity Price per lbSugar Quantity Price: $0.99 Quantity Price per lbMarinara Sauce Quantity Price: $2.99 Quantity Price per qtChicken Soup 7.25oz Quantity Price: $1.49 Quantity Price per canPeanut Butter Quantity Price: $0.30 Quantity Price per ozSliced White Bread Quantity Price: $5.50 Quantity Price per loafSliced Wheat Bread Quantity Price: $5.49 Quantity Price per loafHamburger Bun Quantity Price: $0.50 Quantity Price per eachHot Dog Buns Quantity Price: $0.40 Quantity Price per eachHoagie Rolls Quantity Price: $0.90 Quantity Price per eachDeli MeatsSliced Ham Quantity Price: $4.99 Quantity Price per lbSliced Turkey Quantity Price: $5.05 Quantity Price per lbSliced Salami Quantity Price: $6.00 Quantity Price per lbSliced Pepperoni Quantity Price: $5.25 Quantity Price per lbSeafoodIQF Barramundi Filet Skin On 6-8oz Quantity Price: $5.00 Quantity Price per eachIQF Sea Bass Branzino 6-8oz Filet Quantity Price: $5.00 Quantity Price per eachIQF Flounder Filet 6-8oz Quantity Price: $5.00 Quantity Price per eachShrimp Quantity Price: $9.99 Quantity Price per lbAlcoholBud Light Quantity Price: $12.00 Quantity 6 Pack - BottlesCoors Light Quantity Price: $12.00 Quantity 6 Pack - BottlesMiller Light Quantity Price: $12.00 Quantity 6 Pack - BottlesMichelob Ultra Quantity Price: $14.00 Quantity 6 Pack - BottlesCanyon Roads Cabernet Quantity Price: $12.00 Quantity Wine BottleCanyon Roads Merlot Quantity Price: $12.00 Quantity Wine BottleCanyon Roads Pinot Noir Quantity Price: $12.00 Quantity Wine BottleCanyon Roads Chard Quantity Price: $12.00 Quantity Wine BottleCanyon Roads Pinot Grigio Quantity Price: $12.00 Quantity Wine BottleMiscellaneousToilet Tissue Quantity Price: $1.25 Quantity Price per rollPaper Towel Quantity Price: $2.00 Quantity Price per rollBox of 100 Disposal Gloves Quantity Price: $22.00 Quantity Total $0.00