Guest Name:



Guest Name: |Vacation Rental Name: | |

|Arrival Date and Flight Time: |Departure Date: |

|Credit Card Type: (Please circle!) |Credit Card Number: |

|AMEX VISA MasterCard | |

|Name as it appears on card (middle initials, etc.) |Expiration Date (required): |

|CID number (3 or 4 digit code, generally on back of card) |E-mail address: |

|Billing Address of Cardholder: |

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|Address: _____________________________________________________________________________ |

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|City: ______________________________________________ State: _____________________________ |

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|Country: ________________________________________ Postal Code: ___________________________ |

|Phone Numbers (please include area codes!): |

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|Work (or Daytime) _______________________________________________________________________ |

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|Cell Phone (required): _____________________________________________________________________ |

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|Other numbers we should try? _______________________________________________________________ |

|Cardholder’s signature (required in order to initiate order): |

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|I _____________________________________________________, hereby authorize Grocery Goddesses, LLC |

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|to charge my aforementioned card for the grocery provisioning charges and their agreed upon fees (19% of total Grocery Bill and $35.00 [condo/villa] or $60 |

|[yacht/bareboat] stocking/delivery charge) per my order; sent and signed by me. I am including a copy of a valid picture ID for security purposes. |

All faxes will be confirmed by Grocery Goddesses on receipt. If you have not received confirmation within 48 hours, please re-send your fax.

My Grocery List

Please be as specific as possible!

|Bakery Items: | |Dairy: |

| Bagels | | |Biscuits | |

|Bread | | |Butter | |

|Cakes | | |Coffee mate | |

|Cookies | | |Cottage Cheese | |

|Doughnuts | | |Eggs | |

|English Muffins | | |Juice | |

|Pastries | | |Margarine | |

|Rolls | | |Milk | |

|Muffins | | |Sour Cream | |

|Other: | | |Yoghurt | |

|Beverages: Alcoholic | |Other: | |

|Beer | | | Cheeses: |

|Wine | | |American | |

|Liquor | | |Brie | |

|Cordial | | |Cream | |

|Coolers | | |Gouda | |

|Champagne | | |Feta | |

|Mixers | | |Havarti | |

|Other: | | |Muenster | |

| Beverages: Non-Alcoholic | |Monterey Jack | |

|Coffee | | |Parmesan | |

|Tea Bags | | |Provolone | |

|Sodas | | |Ricotta | |

|Powdered Drink Mix | | |Swiss | |

|Juice | | |Cheddar | |

|Bottled Water | | |Crackers: | |

|Other: | | |Other: | |

| Canned | |Goods: |

|Beans | | |Soups | |

|Chicken | | |Vegetables | |

|Fruit | | |Evaporated Milk | |

|Meats | | |Chef Boyardi | |

|Pie Filling | | |Sloppy Joe Mix | |

| Tuna or Salmon | | |Baby Formula | |

|Pasta Sauce | | |Other: | |

Guest Name: Villa Name: Date:

|Condiments: | |Meats: |

|A-1 Steak Sauce | | |Chicken | |

|Barbeque Sauce | | |Pork/Ham | |

|Ketchup | | |Turkey | |

|Mayonnaise | | |Fish | |

|Mustard | | |Ground Beef | |

|Relish | | |Ribs | |

|Miracle Whip | | |Roast | |

|Olives | | |Steaks | |

|Pickles | | |Sausage | |

|Salad Dressing | | |Cold Cuts | |

|Vinegar | | |Deli Cold Cuts | |

|Salsa | | |Bacon | |

|Hot Sauce | | |Lamb | |

|Worcestershire Sauce | | |Veal | |

|Salt/Pepper, etc. | | |Lobster | |

|Honey/Syrup | | |Shrimp | |

|Other: | | |Other: | |

| Snacks: | | Good Ideas: |

|Candy | | |Olive oil | |

|Chips | | |Other Oil | |

|Cookies | | |Crisco | |

|Nuts | | |Bread Crumbs | |

|Potato Chips | | |Cake/Brownie Mix | |

|Pretzels | | |Canned Frosting | |

|Popcorn | | |Cereals | |

|Other | | |Rice | |

| Beef Jerky | | |Crackers | |

|Dip | | |Croutons | |

|Other: | | |Jams/Jellies | |

Guest Name: Villa Name: Date:

|Other: | |Good Ideas (cont’d): |

|Miscellaneous Items: | |Peanut Butter | |

|Napkins | | |Jell-o | |

|Paper Plates | | |Non-Stick Spray | |

|Paper Towels | | |Pasta | |

|Sandwich Bags | | |Pancake Mix | |

|Plastic Wrap | | |Other: | |

|Tin Foil | | |Frozen Foods: |

|Garbage Bags | | |Dinners/Entrees | |

|Dish Detergent | | |Ice Cream | |

|Soup Bars | | |Pastries/Cakes | |

|Other: | | |Pies | |

|ANYTHING ELSE??? ADD YOUR OWN LIST!! | |Pizza | |

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At Grocery Goddesses we pride ourselves on purchasing quality goods that are delivered to St. Thomas' Visitors and Residents with the highest level of customer service.

When planning your list, please keep in mind the number of people in your party and the number of days you will be staying. Be as specific as possible on brand names, quantities, weights and wine price ranges.

Bear in mind, retail grocery prices are higher than mainland prices as all items must be imported.

Grocery Goddesses shopping fee is 19% of the total grocery bill and a

$35.00 (condos/villas)

$60.00 (yachts/bare boats) delivery/stocking fee.

Local service rates are available for weekly and bi monthly customers. Contact us for these savings. Orders can be placed within 6 months prior to your arrival. Any order placed with less than one full day's notice will be considered a rush order and subject to an additional fee.

A 10% cancellation fee will result if your order is cancelled 24 hours prior to

delivery.

All faxes will be confirmed by Grocery Goddesses on receipt. If you have not received confirmation within 48 hours, please re-send your fax.

We accept payment via:

VISA, MasterCard and American Express. There is no minimum order, but please consider the provisioning fee in order to make our service economically feasible.

Thank you!

We look forward to serving you!

email grocerygoddesses@

Julie 340-642-3014

Fax 973-695-1377

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Thank you for completing this form!

Please fax back (or scan and email) along with your order form to (973) 695-1377

Phone (340) 642-3014 --- E-mail: grocerygoddesses@

Agreement and Authorization

Please, take a moment to print and complete this form

Thank You!

My Name: ________________ My Villa: _________________ Today’s Date:________________

Special Dietary Concerns/ Restrictions: ______ ________________________________________

I accept substitutions of brand/size of equal or higher quality (Please check if you agree)

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