Michigan Muslim COVID Grocery Order Form

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Michigan Muslim COVID Grocery Order Form

If you are at high risk for coronavirus (elderly, chronic condition, immunosuppressed), a volunteer will do your groceries and deliver to you. No one will be turned away for lack of funds!

*CALL 734-210-0316 TO SPEAK TO SOMEONE OVER THE PHONE*

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* Indicates required question

Email *

Your email

Name *

Please enter the product number

Your answer

Phone number *

Your answer

Address *

Your answer

Items required *

Your answer

Estimated budget (if applicable)

Your answer

Anything else? (prescription filled, etc)

Your answer

Payment *

Cash (at door)

Venmo (@INSERT NAME)

PayPal (@INSERT NAME)

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