Sign Up for Delivery | Rosehill Dairy

Name*
First Last
Phone*
Email*
Additional Authorized Person
- Only one name on account
- Add additional name on account
Name
First Last
Phone
Email

Address for Delivery*
Street Address Address Line 2 City ZIP Code
Is your residence an apartment or town-home?
- Single family home
- My residence is an apartment or town-home.
Apartment or Town-home description:
Please note that there are some apartment locations we are not able to deliver to. We also require milk boxes to be on ground level even if your apartment is an upper level unless and exception is granted. Please provide a brief description of your apartment location, any extra instructions on finding your unit, and include the name of the complex if applicable.
Would you like us to provide a milk box?
We will provide a painted wood milk box at no charge. Some customers prefer using their own box or cooler, in which case select "No".
- Yes
- No
Box/Cooler Description
You have selected that you will provide the milk box. Please describe the box or cooler so that the milkman will know what to look for (i.e. blue cooler).
Location of milk box or cooler:*
Please specify the location for the milk box or cooler if it is not next to the front door.

Enter your standing order:
Your standing order is items that you anticipate you'll want on a regular basis. Once we create your account, you will be able to log in to our website, or call in to change your order at any time.
Example: 4 half gallons of 2% milk per week
First Delivery:
After we receive your information, we will let you know what your delivery day is. Please let us know if you would like your first delivery at the next available time, or after a certain date.
- As soon as possible

Please Accept The Terms Below*
Weekly Billing: Charges will be deduced from your method of payment each week, on Wednesday, for that week's delivery. On the last day of the month, you will receive an electronic receipt with the monthly totals, taxes, adjustments and charges included. The monthly delivery fee of $5 per month will be included in the first weekly charge of the calendar month. You can see the weekly subtotals by logging into your account and clicking "Delivery History." We accept ACH auto check payments which are our preferred payment method (easy, automatic, no fees). Credit/debit card payments are accepted with an additional 3.8% processing fee applied.
- I had read and agree to the terms above
Any questions or comments?

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