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