YOUR PROFILE To better serve you, let’s get to know you a little better: Full Name: ___________________________________________________________________ Gender: _____________________________________________________________________ Date of Birth: ________________________________________________________________ Maritial Status: _______________________________________________________________ Adress: _____________________________________________________________________ _____________________________________________________________________________ Do you have any intolerances or allergies (gluten/lactose...)? Please Specify. _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Do you have any items you prefer to exclude from your boxes? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ How many recipients will be benefiting from the subscription plan? _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Embrace the healthy and organic lifestyle through our weekly boxes. The Garden Box The Garden Box is a selection of 12 items/box ranging from organic fresh fruits, vegetables & greens to be sent every week for a fixed period of 1month. The Snacks Box The Mouné Box The Ultimate Box The Ultimate Box contains a full grocery collection from Live Organic Store. Choose 24 items/box to be sent to you every week for a fixed period of 1month. 240 The Mouné Box is a selection of 10 items/box ranging from organic spices, grains, rice, pasta, sauces, jarred foods & herbs selected from our store to be sent to you every week for a fixed period of 1month. The Chilled Box ,000 ll /week The Snacks Box is a selection of 6 items/box ranging from organic snacks & beverages carefully selected to be sent to you every week for a fixed period of 1month. The Chilled Boxis a selection of 6 items/box ranging from organic meat, fish, poultry, eggs & dairy products that will be sent to you every week for a fixed period of 1month. If you selected the Ultimate box, use the list bellow to select what you would like to have in your basket each week. Use the basket icons to specify how many times you would like to receive this item. Each basket represents a week of the month. Apples Lemons Bananas Cucumbers Tomatoes Carrots Produce of the Season _________ _________ _________ _________ _________ Parsley Mint Lettuce Coriander Greens of the Season Thyme Corn Flakes Oat Flakes Other Flakes Oat Bran Muesli Fruits Muesli Chocolate ________ ________ ________ ________ ________ ________ Cocoa Shells ________ ________ ________ ________ ________ Box 6x Eggs Box 12x Eggs Butter/Ghee Goat Labneh Cow Milk Goat Milk Mozzarella Cream Cheese Cheddar Slices Tofu Goat Milk Kefir Cow Labneh Feta Almond Cheese Cow Milk Kefir _________ Rice Milk Soy Milk Quinoa Milk Oat Milk Almond Milk American Coffee Iced Teas White Wine Red Wine Beer Tea Box ________ Fresh Salmon Smoked Salmon Frozen Whole Chicken Australian Tenderloin Fresh Whole Chicken Portioned Meat Sliced Bread Oat Bread Multi Cereal Bread Bran Bread Barley Bread Gluten Free Bread Portioned Chicken Canned Tuna Canned Sardine Canned Anchovies ________ ________ Burger Buns Mini Baguette Oat Pita Bread (No Yeast, No Sugar) _________ _________ _________ Rice Cakes Corn Chips Hummus Chips Lentil Chips Quinoa Chips Dark Chocolate Bar Organic Trail Mix Milk Chocolate Bar Muesli Biscuits Chocolate Biscuits Vanilla Biscuits Protein Bars Energy Bars __________ Quinoa Amaranth Red Lentils Red Beans Burghul Chick Peas Basmati Rice Rice Mix Chia Seeds Flax Seeds Sesame Seeds ________ Tahina Pesto Sauce Nut Butters _________ _________ _________ Peas Corn Tomato Paste Tomato Puree Ready Pasta Sauce Diced Tomatoes Pasta Whole Wheat Spelt Fusilli Penne Spaghetti Lasagna Penne Spaghetti Spaghetti Sedani Fusilli Rye Rice Buckwheat Sedani Penne Fusilli Corn Fusilli Oat Sedani Quinoa Flour Whole Wheat Flour Rye Flour Brown Rice Flour Spelt Flour Coconut Flour Quinoa Sedani Brown Rice Penne Elbows Angel Hair Spaghetti Linguine Oat Flour Chick Pea Flour Almond Flour ________ ________ ________ All-Purpose Garlic Salt Cumin Turmeric Cinnamon ________ Zaatar Mix Black Pepper White Pepper Cayenne Poppy Seeds Chili Powder Mayonnaise Ketchup Oilve Paste Milk Cooking Choco Soy Cooking Cream Rice Cooking Cream Sunflower Oil Coconut Oil Virgin Olive Oil Sesame Oil Brown Rice Vinegar Apple Vinegar Dijon Mustard Chocolate Spread Dark Cooking Choco _________ _________ _________ Balsamic Vinegar ________ ________ ________ ________ ________ Agave Cane Sugar Carob Molasses Grape Molasses Strawberry Jam Apricot Jam Mixed Berry Jam Fig Jam Banana Jam Diabetic Jam (with Agave) ________ ________ Umeboshi Plums Miso Soup Kuzu Tamari Sauce Shoyu Sauce Kombu Nori Hijiki Sencha Tea ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ WE WISH YOU A PLEASANT SHOPPING EXPERIENCE...
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