Online Order Form

Location:

Morden

Winkler

First Name

Last Name

Street Address

City/Town

Email

Phone #

Co-op Member #

Payment selection:

Cash

Cheque

Debit

Gift Card

Charge Account

Prepaid Charge

Credit Card (Please fill out credit card info below or leave blank for a follow up phone call)

Credit Card #

Expiry date

Would you like contactless service?

Yes

No

Delivery or Pick-up

Delivery

Pick-up

Preferred date/time:

DELI ITEMS:

BAKERY ITEMS:

PRODUCE ITEMS:

DAIRY ITEMS:

MEAT ITEMS:

GROCERY ITEMS:

FROZEN ITEMS:

Additional comments & instructions:

THANK YOU FOR SUBMITTING!

Someone will contact you soon.