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Customer Information

Full Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Please note, we only deliver to the Tampa Bay, Florida area.

Street Address City ZIP Code

Will these goods be delivered to you or someone else?(Required)

I'm ordering these items for myself

I'm ordering these items for someone else (example: a loved one)

Full name of person we will deliver to(Required)

First Last

Select the Items You'd like Delivered

Would you like Personal Care items delivered?(Required)

Examples: toothbrushes, toothpaste, mouthwash, bath soap, body wash, lotion, deodorant, shampoo & conditioner

Yes, I would like personal care items delivered

No, I do not want personal care items delivered

Toothbrushes:

ORAL-B CLASSIC | Medium 1 count

COLGATE EXTRA CLEAN | Medium 1 count

AIM PRO MASSAGE | Soft 1 count

AIM PRO MASSAGE | Medium 1 count

CLOSE-UP | Soft 1 count

CLOSE-UP | Medium 1 count

CLOSE-UP | Hard 1 count

REXALL MINT FLOSSER | 90 count

None

Toothpaste:

COLGATE | 4oz advanced whitening

CREST MINT | 100ml

PEPSODENT WHITENING

COLGATE MAX TOTAL | 125ml

ARM & HAMMER CAVITY | 125ml

SENSODYNE | 3.4oz

AQUAFRESH | 3.4oz

PRONAMEL | 3.4oz

None

Mouthwash:

LISTERINE COOL MINT

LISTERINE ORIGINAL | 500ml

CREST | 16oz

CREST | 32oz

SCOPE | 27oz

SCOPE | 33oz

ACT | 19oz

ACT | 28oz

COLGATE | REGULAR

COLGATE | LARGE

None

Body Wash

DOVE ORIGINAL | 539ml

NIVEA WASH | 750ml

AXE WASH EXCITE | 250ml

Bath Soap

DOVE | 47.8oz

DOVE BAR | 2 count

CARESS | 37.20oz

CARESS BAR | 2 count

OLAY | 37.20oz

OLAY BAR | 2 count

IRISH SPRING BAR | 3 count

Lotion

JERGENS | Original scent

AVEENO DAILY | 354oz

ST. IVES HYDRATING | 621ml

SUAVE ALOE SOOTHING | Regular size

CUREL DAILY HEALING | Regular size

VASELINE ESSENTIAL | 295oz

LUBRIDERM DAILY MOISTURE | 473oz

Deodorant

OLD SPICE | 2.6oz

DOVE ORIGINAL | 2.6oz

DEGREE | 3.1oz

DEGREE SPRAY | 3.8oz

SPEED STICK | 3.6oz

AXE | 2.7oz

Shampoo & Conditioner

HEAD & SHOULDERS 2 IN 1 | 11oz

SUAVE 2 IN 1 | 17oz

DOVE FOR MEN + CARE HAIR CARE | 12oz

VO5 | 7.2oz

PANTENE SHAMP/COND 2 IN 1 | 3.1oz

TRESEMME’ SHAMP/COND | 23oz

Incontinence

ADULT WIPES PADS

ASSURANCE WASHCLOTHS | 48ct

PREVAIL PREMIER WASHCLOTHS | 48ct

ASSURANCE WASHCLOTHS | 96ct

PREVAIL PREMIER WASHCLOTHS | 96ct

POISE PADS “RG” LENGTH | 66ct

PREVAIL DAILY PADS | 9.25″

SURE CARE MODERATE | 22ct 4×10″

MAXI PADS WITH WINGS | Large 36ct

ATTENDS WASHCLOTHS | Large 72ct

ATTENDS WASHCLOTHS | Regular 48ct

Would you like Household items delivered?(Required)

Examples: laundry detergent, air freshener, bath tissue, tissue boxes, & bed linens protection

Yes, I would like household items delivered

No, I do not want household items delivered

Laundry Detergent

ARM & HAMMER | 50oz

ALLA ULTRA OXI ACTIVE | 94.5oz

TIDE LIQUID ORIGINAL | 10oz

GAIN LIQUID | 25oz

PUREX FREE & CLEAN | Liquid unscented 15oz

BOUNCE FABRIC SOFTNER SHEETS

Air Freshener

LYSOL SANITIZING SPRAY | 10oz

AIRWICK | 8oz

GLADE AIR FRESHENER | 14oz

Bath Tissue

7TH GENERATION SCOTTS

ESSENTIAL

ANGEL SOFT ANGEL SOFT

Tissue Boxes

ANGEL SOFT | 96 sheets

PUFFS | 116 sheets

KLEENEX BOUTIQUE | 95 sheets

GEORGIA | 100 sheets

Bed Linens Protection

UNDERPADS | Waterproof, washable protection for bedding

Would you like Food items delivered?(Required)

Examples: snacks & coffee

Yes, I would like food items delivered

No, I do not want food items delivered

Snacks

LANCE TOASTY PEANUT BUTTER | 5oz

HONEY BUNS | 4 count

JUICY GELS | 13oz strawberry/orange flavors

OREOS | 4 pack

HONEY ROASTED | 4oz

PISTACHIOS – NO SHELL | 0.75 oz

Coffee

NESTLE COFFEMATE | 12oz

Would you like Pet Care items delivered?(Required)

Examples: dog & cat food

Yes, I would like pet care items delivered

No, I do not want pet care items delivered

Dog Food

TURKEY CUISINE | 3.5oz

Cat Food

MIXED GRILL | 5oz

Delivery Information

How often would you like the selected items to be delivered?(Required)

If you've selected other, please let us know when you'd like your goods delivered:

Do you have any special requests?

Would you like us to go grocery shopping or delivery anything else? Do you need any other help when we are there? Please let us know if there are any other ways we can help below.

Payment Options

How would you like to pay for your delivery?(Required)

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