By Phone:1-888-MRS-MYER	Hours:  M-Fri 8-5:30 Sat 8-5
3 Convenient			or		     (Eastern Standard Time)
                            (902)233-4434
Ways to Order!	  By Fax:(902) 233-4455
		  By Mail: Mrs. Myers Chocolates, Inc.
			   123 Chocolate Way
                           Evansville, IN 90210




Your Address (Shipping Address 1):

Name......
Email.....
Address...
City......
State.....
Zip.......
Country...
Phone.....
 


Send Gift to (Shipping Adress 2) - (if different from above):

Name......
Address...
City......
State.....
Zip.......
Country...
Phone.....
 


Send Gift to (Shipping Adress 3) - (if different from above):

Name......
Address...
City......
State.....
Zip.......
Country...
Phone.....
 


Send Gift to (Shipping Adress 4) - (if different from above):

Name......
Address...
City......
State.....
Zip.......
Country...
Phone.....
 

Product:

Qty

Box Size

Code

Ship to Address #

Item

Coating*

Price

Total

Merchandise Sub Total

Shipping & Handling Charges

GRAND TOTAL


PAYMENT:

 
 Visa 
 Mastercard 
 Discover
 American Express
 
Credit Card Number:  
 
Expiration Date:    
 
 


NOTE: If you do not wish to include your credit card number, leave the credit card fields blank. A representative of Mrs. Myers Chocolates, Inc. will call you to get the required information.


SPECIAL INSTRUCTIONS:

 

 
 


(Shipping & Handling Charges(Per Recipient)


						Shipping & Handling
                                                  is per address
Purchase Total		Regular Shipping

Up to		$13.00	$5.60		Call        for Summer shipping costs.
$13.01	to	$25.00	$7.10
$25.01	to	$50.00	$8.95		There are additional shipping charges on
$50.01	to	$75.00	$9.95		packages that are shipped 2nd Day, Overnite,
$75.01	to	$100.00	$10.95		to Alaska, Hawaii, & Canada.
$100.01	to	$150.00	$13.95
$150.01	to	$200.00	$15.95* 	Please call our toll free number for those 
					prices.

For purchases over $200.00, add $1.00 per $10.00 to last* shipping charge.
Prices effective through April 30, 1998.