CHOCOLATE Easter Egg Order Form

Email completed order form to dkparker71@sbcglobal.net no later than 3/24/13.

First Name: Last Name: Phone: Email Address:

JUMBO Chocolate Eggs ($8 each)

Dark Choc - Vanilla Quantity: Milk Choc - Vanilla Quantity: Dark Choc - Peanut Butter Quantity: Milk Choc - Peanut Butter Quantity: Dark Choc -Cherry Cream Quantity: Milk Choc - Cherry Cream Quantity: Dark Choc - Maple Quantity: Milk Choc - Maple Quantity: Dark Choc - Coconut Quantity: Milk Choc - Coconut Quantity: Dark Choc - Orange Cream Quantity: Milk Choc - Orange Cream Quantity:

MINI Chocolate Eggs - Box of 8 ($9 each)

Assorted Box 1 List filling flavors: Vanilla, Peanut Butter, Cherry, Maple, Coconut, Orange List chocolate: Dark or Milk Example Box: 2 Dark Vanilla, 1 Milk Peanut Butter, 1 Dark Peanut Butter, 2 Milk Cherry, 1 Dark Coconut, 1 Milk Maple Assorted Box 2 List filling flavors: Vanilla, Peanut Butter, Cherry, Maple, Coconut, Orange List chocolate: Dark or Milk Example Box: 2 Dark Vanilla, 1 Milk Peanut Butter, 1 Dark Peanut Butter, 2 Milk Cherry, 1 Dark Coconut, 1 Milk Maple Assorted Box 3 List filling flavors: Vanilla, Peanut Butter, Cherry, Maple, Coconut, Orange List chocolate: Dark or Milk Example Box: 2 Dark Vanilla, 1 Milk Peanut Butter, 1 Dark Peanut Butter, 2 Milk Cherry, 1 Dark Coconut, 1 Milk Maple Assorted Box 4 List filling flavors: Vanilla, Peanut Butter, Cherry, Maple, Coconut, Orange List chocolate: Dark or Milk Example Box: 2 Dark Vanilla, 1 Milk Peanut Butter, 1 Dark Peanut Butter, 2 Milk Cherry, 1 Dark Coconut, 1 Milk Maple ALLERGY NOTE: These candies are made in the same facility and may contain or come in contact with wheat/gluten, eggs, dairy or dairy products, peanuts, soy, or tree nuts.

Order Total:
Total Number of Jumbo Eggs ($8 ea): Total Number of Mini Eggs Boxes ($9 ea): Total Amount Owed: Cash or checks made payable to Debbie Parker upon delivery

Delivery:
Deliver to location: Special Instructions: Date required: