This Order Form ONLY Works with Outlook Express Email NOT with Web-Based Email Services (Yahoo Mail, MSN Mail, Hotmail or Google Mail) - Orders will be confirmed either by Email OR Phone. - "Ship To" is Same as Order Info, Unless Specified in Comment Box All Fields Required * Order / Ship To - Info * First Name: * Last Name: * Address: * City: * State: O H ALAKAZAR CACOCTDEDC FLGAHIIDILIN IAKSKYLAMEMD MAMIMNMSMOMT NENVNHNJNMNY NCNDOHOKORPA RISCSDTNTXUT VTVAWAWVWIWY * Zip Code: * Phone Number: * E-Mail Address: SAMPLE Order Form - Click Here Also available in LIGHT or DARK SUGAR-FREE Chocolate ( POUND-BOX Size ONLY ) ~ Use Check Buttons Below ~ Chocolate Coated Fudge Eggs Quantity Each - Milk 123456 78910 Dark 123456 78910 Five Ounce Fudge Egg $6.00 each Quantity Each - Milk 123456 78910 Dark 123456 78910 Twelve Ounce Fudge Egg $12.00 each Quantity Each - Milk 123456 78910 Dark 123456 78910 Twenty-five Ounce Fudge Egg $24.00 each Boxed Chocolates OR Block Fudge Quantity 123456 78910 1/4 (One-Quarter) LB. Box $6.00 each Quantity 123456 78910 1/2 (One-Half) LB. Box $10.00 each Quantity 123456 78910 1(One) LB. Box $18.00 each * MILK Chocolate Assortment Box DARK Chocolate Assortment Box Mixed Milk & Dark Assortment Box ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Light Sugar-Free Add $5.00 / LB. Dark Sugar-Free Add $5.00 / LB. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Custom Order / Instructions - (Fill In Comment Box Below) Special Instructions Payments Accepted Only in Advance AFTER Order Confirmation : by Cashier's Check or Money Order * Chocolates For Your Order: (Comment Box) (see Chocolates Catalog)
EMAIL: Custom Chocolates Revised: June 13, 2010 Copyright © 2004, LHServices-Webmaster