Call us on: 088 00 17 121

Shopping assistance

Sign up for Shopping assistance

Salutation *
Initials *
Name *
Date of birth *
Street name *
House number *
Postal Code *
Place of residence *
Phone number *

You can fill in the details of a possible contact person later

Email address *

How do you currently take care of groceries?

How do you currently take care of groceries? *
Please give your answer briefly.

Why is it no longer possible to do your own grocery shopping?

Why is it no longer possible to do your own grocery shopping? *
Please give your answer briefly.

Would you like to do the shopping together with the volunteer?

Would you like to do the shopping together?
Would you like to get in touch? *
Contact person name *
Contact person phone number *
Contact person email address *

Who fills out this form?

Who fills out this form?
Who fills out this form?

By submitting this form the customer agrees to the registration of personal data for the purpose of providing services.

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Need help? We'll call you back

Enter your telephone number and we will call you back within one day.

Prefer to call yourself?

We are available on working days between 09.00 am and 3:00 p.m.
Call us on 088 00 17 121

Sign up for Shopping assistance

Salutation *
Initials *
Name *
Date of birth *
Street name *
House number *
Postal Code *
Place of residence *
Phone number *

You can fill in the details of a possible contact person later

Email address *

How do you currently take care of groceries?

How do you currently take care of groceries? *
Please give your answer briefly.

Why is it no longer possible to do your own grocery shopping?

Why is it no longer possible to do your own grocery shopping? *
Please give your answer briefly.

Would you like to do the shopping together with the volunteer?

Would you like to do the shopping together?
Would you like to get in touch? *
Contact person name *
Contact person phone number *
Contact person email address *

Who fills out this form?

Who fills out this form?
Who fills out this form?
By registering you agree to the General Terms and Conditions