Valentine's Order Form
2100 W. 75th St. Prairie Village KS. 66208 P:913-722-2226 :913-722-0143 E-mail laurasfudge@sbcglobal.net
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:__________________________
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4oz. Fudge Hearts $6.99 Milk or Dark
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8oz. Fudge Hearts $11.99 Milk or Dark
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4oz. Truffle Hearts $6.99 Milk or Dark
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8oz. Dark Truffle Hearts $11.99
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4oz.Milk Van. Peanut Butter Hearts $6.99
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4oz. Milk Crispy Peanut Butter Hearts $6.99
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2oz. Milk Marshmallow Hearts $6.99
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5oz. Milk Marshmallow Hearts $11.99
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4oz. Milk Plain Caramel Hearts $6.99
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8oz. Milk Plain Caramel Hearts $11.99
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4oz. Milk Pecan Caramel Hearts $6.99
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8oz. Milk Pecan Caramel Hearts $11.99
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3.5oz. Solid Choc. Hearts Milk-Dark-White $6.99
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3.5oz. Solid Sugar Free Chocolate Hearts $11.99 Milk or Dark
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Visa Card
HEARTS
$______
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Master Card
Shipping To 50 Sates
SHIPPING
$______
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Discover Card
Flat Rate Shipping $9.99 To Each Address
TAX 8.525%
$______
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American Express
Second Day 1 lb. $15.95 Additional lb. $3.00
TOTAL
$______
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Check Amount (Mail Only) $__________
Express Mail 1 lb. $30.00 Additional lb. $6.00
     
Card Numbers_____________________________
  
     
Exp._________
     
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