Grocery Order Form

Add more convenience to your stay by having us coordinate a grocery delivery service. Our shopper will purchase your desired items and deliver them directly to your accommodation.  Your requested items will be placed away neatly where they need to be (i.e. ice cream in the freezer, milk in the fridge, etc.). Please complete the grocery order form below or submit your order request to us at info@mauiactivityconcierge.com. After we receive your list, we will contact you to collect a credit card for payment.

Guest Name (required)

Date of Arrival (required)

Accomodation Name/Address (required)

Contact Phone Number (required)

Contact Email Address (required)

Your Estimated Arrival Time (required)


  • Our shopper strives to fulfill all your requests, however, if an item is not available may the grocery shopper substitute items when possible (additional comments can be placed on the form)
    YesNo
  • The first stop at the grocery store is complimentary. In the event the shopper needs to make multiple stops at different stores to locate items, there is a $30.00 fee per each additional stop. Do you wish the shopper to make multiple stops to locate any items on your list? If no, the shopper may only be able to purchase some of your items.
    YesNo
  • Pricing Details: If the shopper spends a total retail cost on groceries that totals $250.01 or more, the fee for the service is 40% of the total retail cost plus the retail cost of groceries. If the total retail cost of the groceries is $250.00 or less, there is a $90.00 flat fee plus the retail cost of the groceries. We will not know the total cost of the groceries until they are purchased. Do you acknowledge and understand these policies:
    YesNo
  • Availability of grocery items may vary. Organic is offered based on availability.If you have any additional comments, please add them in the comments section below or you can message us after submitting your grocery order form below.
  • BEVERAGES PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Coffee
    Tea
    Bottled Water
    Orange Juice
    Apple Juice
    Cranberry Juice
    Soda/Soft Drinks
    Club Soda
    ADULT BEVERAGES PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Mixers
    Wine
    Beer
    Spirits
    Limes
    Lemons
    Celery
    Other Requests
    Other Requests
    Other Requests
    BREAD ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Loaf
    Bagels
    English Muffins
    Tortillas
    Hamburger Buns
    Hot Dog Buns
    Pita
    Muffins
    Pastries
    Other Requests
    Other Requests
    Other Requests
    PASTA & RICE ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Pasta
    Rice
    Marinara Sauce
    Alfredo Sauce
    Other Requests
    Other Requests
    Other Requests
    DAIRY ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Milk
    Yogurt
    Cheddar Cheese
    Swiss Cheese
    Other Cheese
    Cream Cheese
    Eggs
    Other Requests
    Other Requests
    Other Requests
    FRESH VEGETABLES PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Avocados
    Asparagus
    Broccoli
    Carrots
    Cucumbers
    Corn on the Cob
    Eggplant
    Green Beans
    Garlic
    Lettuce
    Mushrooms
    Onions
    Potatoes
    Peppers
    Romaine Lettuce
    Squash
    Tomatoes
    Other Requests
    Other Requests
    Other Requests
    FRESH FRUITS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Apples
    Bananas
    Cantaloupe
    Strawberries
    Blueberries
    Grapes
    Kiwis
    Mangos
    Oranges
    Grapefruit
    Papaya
    Pineapple
    Watermelon
    Other Requests
    Other Requests
    Other Requests
    BEEF ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Steak
    Hamburger
    Hot Dogs
    Other Requests
    Other Requests
    Other Requests
    CHICKEN ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Breast
    Thighs
    Wings
    Whole Chicken
    Other Requests
    Other Requests
    Other Requests
    PORK ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Bacon
    Sausage
    Other Requests
    Other Requests
    Other Requests
    SPECIALTY MEATS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Veal
    Lamb
    Other Requests
    Other Requests
    Other Requests
    DELI MEAT PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Turkey
    Ham
    Roast Beef
    Salami
    Other Requests
    Other Requests
    Other Requests
    SEAFOOD ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Shrimp
    Crab
    Lobster
    Smoke Salmon
    Poke (ahi)
    Other Requests
    Other Requests
    Other Requests
    CONDIMENTS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Ketchup
    Mustard
    Mayonnaise
    BBQ Sauce
    Peanut Butter
    Jelly/Preserves
    Maple Syrup
    Honey
    Salad Dressing
    Olive Oil
    Balsamic Vinegar
    Pickles
    Olives
    Other Requests
    Other Requests
    Other Requests
    SNACKS/CEREAL PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Cereal
    Granola
    Pancake Mix
    Chips
    Salsa
    Crackers
    Pretzels
    Popcorn
    Cookies
    Nuts
    Other Requests
    Other Requests
    Other Requests
    BABY PRODUCTS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Diapers
    Swim Diapers
    Wipes
    Baby Food
    Formula
    Rice Cereal
    Other Requests
    Other Requests
    Other Requests
    ADDITIONAL ITEMS PLEASE ENTER THE BRAND & SPECIFICS QUANTITY
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests
    Additional Requests



    Grocery Service Pricing & Terms/Conditions

    I understand the service terms and conditions noted above. I understand that it is not possible to prepare an advance quote for this service as each order is different and each order has different items. I accept the charge that will be placed to my credit card for this service. A receipt of the charge will be provided to the email address provided. If you have questions about the delivery service, please contact us at 808-868-0253 or info@MauiActivityConcierge.com before submitting your request. Upon submitting your list we will contact you to collect a credit card to secure the booking.


    Additional Comments: