How to get a hold of us and how to order.

Just fill out the order form below and then press the button at the end of the form marked Send Order.

If you prefer you may call us, fax us or mail us, at the following locations:

Phone:	(800)555-1234
Fax:	(916)265-3198
US Mail:	Mrs. Myers Chocolates 1 Walnut Street Evansville, IN 60098

Press here for Shipping charges.

Please complete a separate order form for each address receiving an order

ORDER DATE:

	Bill To:	Ship To:
NAME:
COMPANY:
ADDRESS:
CITY, ST:	,	,
ZIPCODE:
	YOUR EMAIL:	YOUR PHONE:

METHOD OF PAYMENT:
Since this is not a secure site entering your credit card number is optional. You may FAX your card number or call our telephone number (800)555-1234 with that information if you are concerned about online security.
VISA MASTERCARD CARD #: EXP. DATE:

Please indicate type of chocolate for each item; Light, all Dark or Mix. All of our products can be made with Dark, Milk, or White chocolate.

BOXED CHOCOLATES
Item	Qty.	Type	Chocolate	Weight
1.		Chocolates (assort) Creams Nut & Chew All One Kind Chocolate Covered Nuts	Dark Milk White Dark & Milk	1 1/8 lb. 2 1/4 lb. 4 1/2 lb.
2.		Chocolates (Assort) Creams Nut & Chew All One Kind Chocolate Covered Nuts	Dark Milk White Dark & Milk	1 1/8 lb. 2 1/4 lbs. 4 1/2 lbs.
3.		Chocolates (Assort) Creams Nut & Chew All One Kind Chocolate Covered Nuts	Dark Milk White Dark & Milk	1 1/8 lb. 2 1/4 lbs. 4 1/2 lbs.
GIFT PACKS
Item	Qty.	Code	Chocolate	Weight
1.		GP2 GP3 GP4 GP5	Dark Milk White Dark & Milk	n/a n/a
2.		GP2 GP3 GP4 GP5	Dark Milk White Dark & Milk	n/a n/a
3.		GP2 GP3 GP4 GP5	Dark Milk White Dark & Milk	n/a n/a
SUGAR FREE CANDIES & TAFFIES
Item	Qty.	Candy	Weight
1.		Assorted Taffy Choc Fudge Sundae Fruit Chews Fudge Caramel Vanilla Caramel Mint Caramel Butterscotch Candy Icy Peppermint Candy Lollipop Mix Fruit Coffee Time Starlite Mints Licorice Cinnamon Root Beer Almond Buttercrunch box Cherry Cordials box Fudge Meltaways box Orange Sherbert box Almond Bark Cashew Bark	8 oz. 7 oz. 1 lb. 1 3/4 lb.
2.		Assorted Taffy Choc Fudge Sundae Fruit Chews Fudge Caramel Vanilla Caramel Mint Caramel Butterscotch Candy Icy Peppermint Candy Lollipop Mix Fruit Coffee Time Starlite Mints Licorice Cinnamon Root Beer Almond Buttercrunch box Cherry Cordials box Fudge Meltaways box Orange Sherbert box Almond Bark Cashew Bark	8 oz. 7 oz. 1 lb. 1 3/4 lb.
3.		Assorted Taffy Choc Fudge Sundae Fruit Chews Fudge Caramel Vanilla Caramel Mint Caramel Butterscotch Candy Icy Peppermint Candy Lollipop Mix Fruit Coffee Time Starlite Mints Licorice Cinnamon Root Beer Almond Buttercrunch box Cherry Cordials box Fudge Meltaways box Orange Sherbert box Almond Bark Cashew Bark	8 oz. 7 oz. 1 lb. 1 3/4 lb.

GIFT WRAPPED? YES -- NO

GIFT CARD TO READ: