Essentially Chocolate Order Form

Contact Information for Essentially Chocolate
PHONE #: 207-790-1130
info@essentiallychocolate.com

Please complete the form below.

Name:

Address:

Apt/Suite #:

City:

State:

Zip Code:

Your Contact Information

Phone:

Email:

Payment Information:

Check Money Order

Make All Payments to the order of:

Essentially Chocolate

Click here for price list.

Need item to arrive by:

Individual orders require a 2 week lead time to accomodate requests in a timely manner.

Your Itemized Order

Item	Quantity	Price
		$
		$
	Subtotal:	$
* Sales Tax:		$
** Shipping/Handling:		$
*** Added Cooling Insulation:		$
Total Amount:		$
* FOR SALES IS WITHIN NJ THERE IS AN ADDED SALES TAX OF 7% OUTSIDE NJ, CUSTOMER TO PAY THEIR OWN STATES’ TAX. WE RECOMMEND 2-DAY AIR OR WITHIN 2 DAYS BY GROUND FOR ALL PACKAGES. *DEPENDING UPON TIME OF YEAR ITEMS MAY NEED TO BE SPECIALLY PACKED.

Please ship order to the address below:

To:

Address:

Apt/Suite #:

City:

State:

Zip Code:

Must provide phone # for delivery:

Please give an address where there will be someone there to accept the package.