P.O. Box 2598

Florence, OR  97439

[email protected]

Fax:  1-541-902-7843

Toll-free phone/fax:  1-866-362-6124

www.consciouschocolate.biz

 

 

Click Here to Download a PDF order form

 

Retail Order       Message Lines:     1. Compassion & Mercy, 2.  Peace & Abundance, 3.  Attitude & Gratitude,

4.  Romance (“With Heart in Hand”), 5.  My Sentiments Exactly (custom message(s)

 

Message Theme

Extra Message

Qty x Cost

Message

Subtotal

Price per Box

Quantity

Subtotal

Caramel Silk Truffles

 

 

 

 

 

 

7 piece assorted box

1 2 3 4 5

x $0.50

 

$14.00

 

 

French Creams

 

 

 

 

 

 

6 piece assorted, 3 messages

1 2 3 4 5

x $0.50

 

$14.00

 

 

  15 pieces assorted, 4 messages

1 2 3 4 5

x $0.50

 

$24.00

 

 

  24 pieces assorted, 6 messages

1 2 3 4 5

x $0.50

 

$35.00

 

 

Hotei Buddha

 

 

 

 

 

 

5 piece boxed set

1 2 3 4

x $0.50

 

$12.00

 

 

7 piece boxed set

1 2 3 4

x $0.50

 

$16.00

 

 

9 piece boxed set

1 2 3 4

x $0.50

 

$20.00

 

 

Single Buddha

1 2 3 4

 

 

$3.25 ea.

 

 

Frog Love

 

   Single Frog

1 2 3 4

 

 

$3.25 ea.

 

 

My Sentiments Exactly

Please add a separate page with your personal message(s) .

6 piece

French Creams

x $1.50

 

$12.00 + #messages

 

 

15 pieces

French Creams

x $1.50

 

$17.00+ #messages

 

 

24 pieces

French Creams

x $1.50

 

$35.00+ #messages

 

 

7 pieces

Caramel Silk Truffles

x $1.50

 

$14.00+ #messages

 

 

 

 

 

 

 

Shipping & Handling

 

 

 

 

 

 

TOTAL

 

 

Shipping Address:

 

Name:                          

Company Name:           

Street Address:             

City, State, Zip:            

Phone:                         

Payment Method:

Check or Money Order Enclosed     

 

Visa or Discover Credit Card:

Cardholder Name:         

Credit Card Number:      

 

Expiration Date:            

Credit Card Billing Address:  if different from shipping address

 

 

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