Take Grocery Delivery Orders Without Substitution Surprises

Help your neighborhood grocery store take home delivery orders with shopping lists, photo uploads, drop-off notes, and allergy-aware substitution rules.

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Neighborhood Grocery Store Home Delivery Order & Item Substitution Preferences Form

Full Name

· · ·

Mobile Phone Number

· · ·

Email Address

· · ·

Submit

This grocery home delivery order form gives neighborhood grocers and corner markets a simple way to accept delivery orders online. Customers enter their name, mobile number, email, and delivery address, pick a preferred delivery date and time window, choose a drop-off preference, and add instructions about gate or buzzer codes, parking, pets, and where to leave their groceries. They can type out a shopping list or upload product photos or a picture of their full handwritten list, then choose a bagging preference and payment method.

What sets this template apart is its dedicated item substitution section. Shoppers tell you exactly what to do if an item is out of stock and no substitute is listed, which types of substitutions are acceptable, and the maximum price they will accept for a replacement. They can also flag dietary needs and allergies to respect and name any items that must never be substituted, so your pickers have clear guidance before they start filling the order.

Built for independent grocery stores, specialty food shops, co-ops, and local delivery services, this template lets you offer home delivery without a complex e-commerce setup. Clear substitution rules mean fewer mid-shop phone calls, fewer refunds and returns, and better protection for customers with food allergies. Customize the fields, add your store branding, and start taking grocery delivery orders in minutes.

3 Pages

18 Questions

~6min To complete

Free Included on every plan

Field types Dropdown ×4 Single Choice ×2 Long Text ×2 Multiple Choice ×2 Full Name Phone Email Address Date Table / Grid File Upload termsandconditions

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Customer & Delivery Details 8 questions

Customer & Delivery Details

1 Full Name * Full Name

2 Mobile Phone Number * Phone

3 Email Address * Email

4 Delivery Address * Address

5 Preferred Delivery Date * Date

6 Preferred Delivery Window * Dropdown

7 Drop-off Preference * Single Choice

8 Delivery Instructions (gate or buzzer code, parking, pets, where to leave groceries) Long Text

Page 2 Grocery Order & Payment 4 questions

Your Grocery Order

1 Shopping List * Table / Grid

2 Upload Product Photos or Your Full Handwritten List File Upload

3 Bagging Preference Single Choice

4 Payment Method * Dropdown

Page 3 Item Substitution Preferences 6 questions

Item Substitution Preferences

1 If an Item Is Out of Stock and No Substitute Is Listed * Dropdown

2 Acceptable Substitution Types Multiple Choice

3 Price Limit for Substitute Items Dropdown

4 Dietary Needs & Allergies to Respect When Substituting Multiple Choice

5 Allergy Details or Items That Must Never Be Substituted Long Text

6 I agree to the delivery terms and understand that final prices may vary for items sold by weight and for approved substitutions, that out-of-stock items without an approved substitute will be refunded, and that a valid photo ID is required at delivery for alcohol or tobacco products * termsandconditions

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.