Valentine's Order Form
2100 W. 75th St. Prairie Village KS. 66208 P:913-722-2226 :913-722-0143 E-mail laurasfudge1970@gmail.com
HOME CHOCOLATE FUDGE POPCORN CANS GIFT BASKETS ASSORTED CHOCOLATE CANDY ORDER FORM VALENTINE'S DAY POPCORN ORDER FORM
SHIP ON:_____________________________
FROM:_______________________________
TO:__________________________________
ADDRESS:____________________________
ADDRESS:____________________________
CITY:________________________________
CITY:________________________________
STATE:____________________ZIP:_______
STATE:____________________ZIP:_______
DAY TIME PHONE:___________________
GIFT CARD:__________________________
______________________________________
4oz. Fudge Hearts $8.99 Milk or Dark
Print First Names
8oz. Fudge Hearts $14.99 Milk or Dark
Print First Names
4oz. Dark Truffle Hearts $8.99
Print First Names
8oz. Dark Truffle Hearts $14.99
Print First Names
4oz.Milk Van. Peanut Butter Hearts $8.99
Print First Names
4oz. Milk Crispy Peanut Butter Hearts $8.99
Print First Names
2oz. Milk Marshmallow Hearts $8.99
Print First Names
5oz. Milk Marshmallow Hearts $14.99
Print First Names
4oz. Milk Plain Caramel Hearts $8.99
Print First Names
8oz. Milk Plain Caramel Hearts $14.99
Print First Names
4oz. Milk Pecan Caramel Hearts $8.99
Print First Names
8oz. Milk Pecan Caramel Hearts $14.99
Print First Names
3.5oz. Solid Choc. Hearts Milk-Dark-White $8.99
Print First Names
3.5oz. Solid Sugar Free Chocolate Hearts $14.99 Milk or Dark
Print First Names
   
____
Visa Card
HEARTS
$______
____
Master Card
Shipping To 50 Sates
SHIPPING
$______
____
Discover Card
Flat Rate Shipping $9.99 To Each Address
TAX 8.725%
$______
____
American Express
Express Mail 1 lb. $30.00 Additional lb. $6.00
TOTAL
$______
____
Check Amount (Mail Only) $__________
     
Card Numbers_____________________________
 
     
Exp._________
     
PRINT THIS PAGE TO FAX OR MAIL