Amy's Custom Chocolates ~ Order Form

Amy's Custom Chocolates - Order Form Please fill out this form completely!

This Order Form ONLY Works with Outlook (Express) Email
NOT with Web-Based Email Services (Yahoo 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

Order / Ship To - Info
       *  First Name:        *  Last Name:

           *  Address:     *  City:

           *  State:       *  Zip Code:   *  Phone Number:

                 *  E-Mail Address:               All Fields Required*

    Cinnamon-Pecan Coffee Cake
   Quantity Each -    No Nuts       Loaf Size - $4.00  each

   Quantity Each -    No Nuts     Bundt Size - $12.00  each

Boxed Chocolates OR Block Fudge
Quantity 1/4 (One-Quarter) LB. Box $6.00 each

Quantity 1/2 (One-Half) LB. Box $10.00 each

Quantity 1(One) LB. Box $18.00 each

* MILK Chocolate * DARK Chocolate * Mixed Milk & Dark
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Custom Order / Instructions - (Fill In Comment Box Below)

Special Instructions Here               Advance Payments Only by Cashier's Check or Money Order - Payable to: Amy Hendricks
       *  Selection of Chocolates: (Use Comment Box)

- Orders will be confirmed either by Email OR Phone. -

After clicking SUBMIT, Order is sent to your Outlook (Express) Email "OUTBOX".
Check your Email, so that it may be Forwarded!
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http://www.AmysCustomChocolates.com