PRIVI Member Grocery Order Form

Fill out the form below and enjoy your fully stocked fridge—without the hassle!

Full Name

Phone Number

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Email Address

Delivery Address

Requested Delivery Date / Arrival Date

You may schedule up to 4 deliveries per month. Submit this form each time you need a delivery.

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DD

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How would you like to submit your grocery list?

I have my grocery list ready now.

I will email my grocery list at least 48 hours before delivery.

Grocery List

Please list the grocery items you’d like us to purchase. You may also request specific brands, organic options, or preferred grocery stores (e.g., Whole Foods, Publix, Harris Teeter, etc.). If an item is unavailable, we will choose the closest alternative unless you specify “No Substitutions” next to an item. Example Format: Organic eggs (Vital Farms preferred) Oat milk (Oatly, but any brand is fine) Fresh fruit – bananas, strawberries, blueberries Bread (gluten-free, Canyon Bakehouse brand) Chicken breast (from Whole Foods only, no substitutions) If you are sending your grocery list later, please email it to us at privicharleston@gmail.com at least 48 hours before delivery.

How should we delivery your groceries?

Drop off at the door

Stock in the fridge and pantry

Terms and Conditions

I agree to the terms and conditions below and understand I must complete checkout after submitting this form to complete my order.

Terms and Conditions

Payment: You will be responsible for reimbursing the total grocery bill after delivery.
Additional Fee: If the total grocery bill exceeds $300, a 15% service fee will be applied to the total amount.
Cancellation: If you decide to cancel a delivery within 24 hours, please note that you will not be eligible for a replacement delivery that month. Deliveries are limited to 4 per month, and unused deliveries do not roll over to the next month.
Agreement: By proceeding, you confirm that you understand and accept the payment terms.