Sign up for milk delivery service below
We will send a confirmation email with your customer number and all the details to start service
* Required Field
*First Name:
*Last Name:
*Email:
*Address:
*City & State:
*zip:
*Phone:
Cell Phone:
salesperson name, coupon or offer #
How did you hear about us
Standing Order: Please fill out the following section to let us know what products you would like delivered each week.
We refer to this as the "standing order".  We deliver these products automatically on your delivery day unless we hear
otherwise.  As long as you let us know by 9:00am the day before your delivery you are welcome to change your
standing order or add or subtract products for a specified number of weeks. All products can be managed in the
customer area or as always you can call us.
*Products Categories (check all that apply)
Fat Free (Half Gal.)
1% (Half Gal.)
2% (Half Gal)
Whole Milk (Half Gal.)
Organic Fat Free (Half Gal.)
Organic 1% (Half Gal.)
Organic 2% Half Gal.)
Organic Whole Milk (Half Gal.)
*Product Categories (Check all that apply)

Milk (4 Half Gal. Minimum Required)

Bi-Products

Bread -
coming soon

Eggs (please select the type and amount below)
3 half gal. minimum -
see FAQ for substitutes
number of doz & type eggs
Please fill out the following information. By filling out this from you agree to allow Portland Milk to charge your checking account for the amount
due on your delivery day.  The charge will be made each week of your delivery.  Charges may not show up on your account for a few days
thereafter.
*I agree to allow Portland Milk to make a one time charge to my checking account for $15.00 ($15.00 setup fee).I Authorize funds to be
withdrawn from my checking account each week, for the amount of my delivery and delivery fee.. Please type your full name if you agree to
these terms of service.
Terms Of Service: Please read and check each of the following terms of service. (we cannot set up delivery service without
your agreement to all terms).

*Please remember to call or e-mail us up to 9:00 am the day before your delivery to cancel or change your order. We              
cannot accept after hour order changes and/or notes left for our drivers.
I agree

*You will receive your invoice via email weekly. Your checking account will be charged each week of your weekly delivery. You
hereby authorize Portland Milk to deduct the amount of your weekly delivery from your checking account.
I authorize Portland Milk to withdraw funds from my checking account for products that are delivered.

*Would you prefer to use your own cooler or purchase a milk box? The cost of the Milk Box is $35.00.

Yes - I would like to buy a Milk Box.

No - I will use my own cooler

*There is a one time setup fee of $15.00 for initiating service.
I agree

*In addition to your product costs a delivery fee of $1.75 and any applicable sales tax will be charged.
I agree


Please fill out the following information. By filling out this from you agree to allow Portland Milk to charge your checking
account for the amount due on your bill from that week.  The charges will be made every Friday for that weeks delivery.  
Charges may not show up on your account for a few days thereafter depending on where you bank.

WE DO NOT ACCEPT CREDIT CARDS OR DEBIT CARDS AT THIS TIME
After your account is set up you will be emailed:
your customer number,  your delivery day, the day of your first delivery day and any other information
You will be required to enter you ACH information in the secure customer area before your 1st delivery.
*Please type your full name below as an electronic signature authorizing Portland Milk to withdraw funds
(your checking information will be required to be entered in the customer area of the website after customer number is establish)
*
Click here to send any question
Portland Milk
Home Delivery