* indicates required fields
First Name* :
Last Name* :
Title :
Organization :
Address* :
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City, Town or Village* :
State* :
Zip Code* :
Phone Number* :
Email* :
Birthday :
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mm/dd We may be sending a special coupon or gift in the future!
Are children living at your residence? :
If yes, how many? :
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Password* :
Re-Type Password* :
Where did you hear about us?* :
Yes, it is OK to send me email notifications regarding
Delivery Details
We do require that you have a picnic cooler with at least a 40-quart capacity (holds 7 ½ gallons). Or a refrigerator that is accessible to our driver. If you do not have a refrigerator or cooler, then you may purchase a Crescent Ridge Metal Milk Box from us, holds 9 1/2 gals. and other products (white) for $40.00.
Yes, I would like to purchase the new vintage Crescent Ridge metal milk box for only $40.00.
Yes, I have a refrigerator that is accessible to the driver.
No, I will use a cooler of my own.
It is also helpful to our drivers if we know where you will be keeping your cooler. Please select one of the following choices:
Please call us with a door code as we would be happy to place your products in a refrigerator.
If there are any further delivery instructions, please tell us in the space provided below.
Further Delivery
This type of information will help us better serve you. Please print out a copy of this form for your records. We request that you leave a check for $25 with your first delivery. This will show as a credit on the bill you receive one week later, with your delivery.
In our effort to fight spam, we need you to enter the word that best describes the image to the right in order to submit the form.
You should hear back from us within two business days with your Account NumberThank You.
