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| Step 1: Print this order form. Step 2: Fill it out (you can't fill it out on-line). Step 3: Mail it to the address below. |
| After printing, click HERE to return to How to Order (where you will find important shipping information). | |
| Name | ||
| Address | ||
| City | State | Zip |
| Daytime phone | How did you hear about us? | |
| Quantity | Item Name | Price | Size | Subtotal | Special Instructions or Gift Message |
| Ship to: Name | ||
| Address | ||
| City | State | Zip |
| Quantity | Item Name | Price | Size | Subtotal | Special Instructions or Gift Message |
| Ship to: Name | ||
| Address | ||
| City | State | Zip |
| Please use additional paper or copy this form for additional orders. | ||
| Payment Method (please circle one): | |||||
| Check | Money Order | VISA | Mastercard | Order Subtotal | |
| Credit Card #: | Sales Tax | ||||
| Exp. Date: | Security Code: | Shipping | |||
| Signature | TOTAL | ||||
| Please make check
payable to: Chesapeake Chocolates, Inc. 11426 Washington Plaza West Reston, VA 20190 |
Our chocolate is freshly made and tastes best if
eaten within 2-3 weeks. Please order it to arrive just prior to the
occasion and enjoy! Thank you for your order! |
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