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Melli Chocolates LLC Order Form |
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| Billing To: | |||||||||
| First Name | Last | ||||||||
| Address | |||||||||
| Address | |||||||||
| City | State | Zip | |||||||
| Phone (day) | Fax | ||||||||
| Ship To (if different from above) or Gift Recipient: | |||||||||
| First Name | Last | ||||||||
| Address | |||||||||
| Address | |||||||||
| City | State | Zip | |||||||
| Purchases: | |||||||||
| Qty | Description - please note milk, dark, white, or assorted. | Size | Gift Box | Unit Price | Total Price | ||||
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$ |
$ |
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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% | $ | ||||||||
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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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