ORDER FORM TO ORDER BY MAIL,

LAST DAY TO ORDER BY PHONE FOR EASTER DELIVERY: SEND ORDER AND CHECK TO:
FRIDAY, APRIL 15
some products may sell out, so it is best to order early

NAME: ________________________________________________
ADDRESS: _____________________________________________
CITY: _____________________ STATE: _______ ZIP: __________
DAYTIME PHONE: (______)________________________________
EMAIL: ________________________________________________
4129 HARVEY AVE.
WANT YOUR ORDER SHIPPED TO YOUR OFFICE INSTEAD? “ yes! WESTERN SPRINGS, IL 60558
TO ORDER BY PHONE:
ADDRESS: ______________________________________________
CALL (708) 246-2823 AND
CITY: _____________________ STATE: _______ ZIP: ___________ SEND CHECK SEPARATELY

ORDER TO BE SENT TO ABOVE ADDRESS:

QUANTITY ITEM NAME PRICE EACH TOTAL PRICE

MERCHANDISE TOTAL

SHIPPING CHARGES **
U.S. SHIPPING & HANDLING CHARGES
MERCHANDISE TOTAL UPS GROUND TOTAL FROM OTHER SIDE
up to $20.00.............................................$5.95
OF FORM
$20.01 - $50.00........................................$7.95
$50.01 and up ................. FLAT RATE: $8.95
ORDER GRAND TOTAL
Call for shipping charges to destinations outside U.S.
and for rates for expedited shipping. Please enclose check with order
Make checks payable to: CocoLoco Chocolates
ORDER W ILL NOT SHIP UNTIL PAYMENT IS RECEIVED

uu LOCAL CUSTOMERS CAN PICK UP ORDERS tt

** NOTE: If you are ordering gifts and having them shipped directly to the recipient (order form on reverse),
please calculate shipping charges for each address separately.
GIFT ORDERS TO BE SENT DIRECTLY TO RECIPIENT

GIFT #1:
QUANTITY ITEM NAME TOTAL PRICE

MERCHANDISE TOTAL

u Ship to SHIPPING CHARGES (see chart on reverse)

Name, address:

TOTAL FOR GIFT #1

u Message on gift card:

GIFT #2:
QUANTITY ITEM NAME TOTAL PRICE

MERCHANDISE TOTAL

u Ship to SHIPPING CHARGES (see chart on reverse)

Name, address:

TOTAL FOR GIFT #2

u Message on gift card: