Lettuce Delivery Registration

Please complete the form below, we will contact you for final delivery account set up

Name

First Name

Last Name

Email

Phone

(###)

###

####

How Many Bags Per Delivery

How Many Deliveries Per Month

Delivery Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Special Instructions

Special Delivery Instructions

Venmo Username

If paying by check, please write in "Check" or "Cash"