Melli Chocolates LLC Order Form |
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Phone (day) | Fax | ||||||||
Ship To (if different from above) or Gift Recipient: | |||||||||
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Address | |||||||||
Address | |||||||||
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Purchases: | |||||||||
Qty | Description - please note milk, dark, white, or assorted. | Size | Gift Box | Unit Price | Total Price | ||||
$ |
$ |
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$ | $ | ||||||||
$ | $ | ||||||||
$ | $ | ||||||||
$ | $ | ||||||||
$ | $ | ||||||||
$ | $ | ||||||||
Merchandise Total | $ | ||||||||
Gift Box Charge ($.50 each) | $ | ||||||||
Order by Telephone 904-689-9920 |
if no answer please leave message and number | Subtotal | $ | ||||||
WI residents add 5.5% | $ | ||||||||
Payment Method please enclose check / money order OR |
Shipping Charge $7.50 per box |
$ | |||||||
Visa MasterCard Discover AMEX | Total | $ | |||||||
Exp.Date__ __/__ __/ __ __ CID # (last 3 on back) __/__/__ No.____________________________________ |
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Signature (as shown on card): Print: |
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