Colorful Icelandics
ORDER FORM

Date:______________________

Ordered From:
Name______________________________________________________________________

Address:____________________________________________________________________

City:________________________________________________________________________

State:_________________________________Zip:___________________________________

Phone:______________________________________________________________________

Cell Phone:__________________________________________________________________

Email Address:_______________________________________________________________

#         Item Number      QTY.         Item Description   Color        Size   Color           Price         Total

1__________________________________________________________________________

2.__________________________________________________________________________

3.__________________________________________________________________________

4.__________________________________________________________________________

5.__________________________________________________________________________

6.__________________________________________________________________________

Method of Payment (Sorry, no cash, stamps or C. O.D.s)                             Sub Total____________
         
                                                                                            For Mich. Orders Only
                                                                                             Add 6% Sale Tax ____________
(   ) Check/Money Order (A $25. fee  will be charge on all checks for Collection


                                                            Call for Shipping and Handling________________

                                                                                               Total_____________________
ALL CREDIT CARD ORDERS WILL BE UNDER OUR PARENT
COMPANY  ANNE'S GOURMET CHOCOLATES

VISA (13 OR 16 DIGITS)_________________________________________________________

MASTERCARD (16 DIGITS)______________________________________________________

Exp Date MO.________________________Yr._______________________________________

The three numbers on the back of the on the signature bar______________________________
PRINT CLEARLY
Make all checks/Money Order out to
A. Johnson
PLEASE MAKE ALL CHECKS/MONEY ORDERS
OUT TO   A. JOHNSON
Phone: 734-652-8810  or

you can fax in the order to:  734-529-3337
Print out the order form or you can fax us the order