Get Meals Form

I want to order meals from Kelowna Meals On Wheels

Name *

First

Last

Are you an existing customer of Kelowna Meals On Wheels? *

Yes, I’m an existing customer.
No, this is my first time ordering meals.

Submit a one-time application to become a customer of Kelowna Meals On Wheels.

Customer Email Address *

Customer Primary Phone Number *

Customer Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is the Customer's Primary Phone Number? *

Mobile Phone
Home Phone

Provide the emergency contact of the customer.

Emergency Contact Name *

First

Last

Emergency Contact Relationship to Customer *

Emergency Contact Email Address *

Emergency Contact Primary Phone Number *

What is the Emergency Contact's Primary Phone Number? *

Mobile Phone
Home Phone

Provide the information for the customer.

Customer Date of Birth *

What are the allergies, dietary restrictions, and food dislikes of the customer? *

Please share the reason for requesting the meal program. *

Can we share the allergies, dietary restrictions, and food dislikes with the Chef of our Meal provider? *

Yes, Kelowna Meals On Wheels can share my allergies, dietary restrictions, and food dislikes with the Chef
No, do not share my information.

Please share any special instructions for accessing the customer’s front door for meal deliveries.

Please share any special instructions for accessing the customer's front door for meal deliveries.

Kelowna Meals On Wheels requires a credit card on file to process meal payments and will call the credit card holder for the card details.

Who's credit card will be on file? *

Customer’s credit card
Emergency Contact’s credit card
Another person’s credit card

Name of credit card holder *

First

Last

Email of credit card holder *

Phone number of credit card holder *

Credit Card Holder's relationship to Customer *

How did you hear about Kelowna Meals On Wheels?

How did you hear about Kelowna Meals On Wheels? *

Previous knowledge
Family or friend
Meals On Wheels volunteer
Google or other online browser
Hospital or other care provider
Other

Other [How did you hear about Kelowna Meals On Wheels?] *

Would you like to select your own meals or have our chef select for you?

Would you like to select your own meals or have our chef select for you? *

Have the chef select my meals based on my allergies, dietary restrictions, dislikes, and previous orders.
I would like to upload a pdf copy of my meal selections.

Click here to download menu

Complete this PDF form and download it; you will need to reupload it in the next step. *

Complete this PDF form and download it; you will need to reupload it in the next step.

form Email share

Upload your Meals PDF form here

File Upload *

Click or drag a file to this area to upload.

I have completed the form and uploaded it successfully. *

I have completed the form and uploaded it successfully.

How many meals would you like to receive each week?

First week of the month.

(How many meals would you like to receive each week?) First week of the month.

Second week of the month.

Third week of the month.

Third week of the month

I want to order meals from Kelowna Meals On Wheels

Submit a one-time application to become a customer of Kelowna Meals On Wheels.

Provide the emergency contact of the customer.

Provide the information for the customer.

Please share any special instructions for accessing the customer’s front door for meal deliveries.

Kelowna Meals On Wheels requires a credit card on file to process meal payments and will call the credit card holder for the card details.

How did you hear about Kelowna Meals On Wheels?

Would you like to select your own meals or have our chef select for you?

Click here to download menu

Upload your Meals PDF form here

How many meals would you like to receive each week?

First week of the month.

Second week of the month.

Third week of the month.

Fourth week of the month.

Fifth week of the month.

Are there any meals you wished we offered? Share your comments and suggestions.

Meals On Wheels