~ All That Chocolate ~
3055 Maple Road, Newfane, NY 14108
Phone: (716) 751-6105 ~ Fax: (716) 751-3951
Email ~ AllThatCho@aol.com
Please Print & Fax or Mail ALL page(s) of the following forms.
For your security, All That Chocolate will confirm all information and costs prior to shipping.

Today’s Date:________________ Required Delivery Date:________________
Ordered by:

Name:		  

Address:		  

City:		  

State:		  

Zip:		  

Phone:		  

Delivered to:

Name:		  

Address:		  

City:		  

State:		  

Zip:		  

Phone:		  
Residential or Nonresidential?:  

PRODUCTS:
Fill in quantity ( = pieces) and total price for each item desired:

No.

Description

Price

Quantity

Total Price

1

Seasonal Lollipops
(approx. 3 oz. ea.)
$3.25 ea.

$

2

Dipped Pretzel
(Caramel/Pecan/Milk Chocolate 3 oz.)
$3.75 ea.

$

3

Milk Chocolate Dipped Miniature Biscotti
(6 oz. Bag)
$8.50 ea.

$

4

Milk Chocolate Solid Season Miniature
(6 oz. Box)
$6.75 ea.

$

5

Milk Chocolate Covered Pretzel
(6 oz. Box)
$6.75 ea.

$

6

Heavenly Mix
(3 oz. Gold Foiled Box)
$5.00 ea.

$

7

Heavenly Mix
(8 oz. Resealable Silver Bag)
$7.00 ea.

$

8

Heavenly Mix
(14 oz. Resealable Gold Bag)
$11.00 ea.

$

9

Assorted Truffles
(Approx. 4 oz. Box)
$8.00 ea.

$

10

Chocolate Caramel Apple
With Seasonal Decorative
(WITH Nuts approximately 20 oz.)
$15.00 ea.

$

11

Chocolate Caramel Apple
With Seasonal Decorative
(NO Nuts approximately 20 oz.)
$15.00 ea.

$

12

Traditional Mixed Roasted Nuts
(Premium Quality, Peanut Free, 15 oz. Bag)
$11.00 ea.

$

13

Milk Chocolate Sponge Candy
(6 oz. Box)
$6.75 ea.

$

14

Milk Chocolate Peanut Butter Novelties
(6 oz. Box)
$9.00 ea.

$

15

Milk Chocolate Caramel Pecan Patties
(6 oz. Box)
$9.00 ea.

$

16

Milk Chocolate Nut Bark
(6 oz. Box)

$9.00 ea.

$

17

Milk Chocolate Covered Popcorn
(3 oz. Bag)

$4.00 ea.

$

18

Milk Chocolate Covered Popcorn
(6 oz. Bag)

$7.50 ea.

$

19

Milk Chocolate Peanut Clusters
(6 oz. Boxed)

$9.00 ea.

$

20

Milk Chocolate Raisin Clusters
(6 oz. Boxed)

$9.00 ea.

$

21

Milk Chocolate Coconut Clusters
(6 oz. Boxed)

$9.00 ea.

$

22

Assorted Gourmet Gift Baskets
(Customized Gift Basket made to order.
Any size/price range available.)
$

$

23

Special Orders
(Additional items available on request.)
$

$

24

 Gingerbread Tree Cookie
(White & Milk Chocolate, individually wrapped)
$3.95 ea.

$

25

Dark Chocolate Laced Candy Cane
(Individually wrapped)
$3.95 ea.

$

26

Dark Chocolate Coconut Macaroons
(7 oz. Bag)
$8.50 ea.

$

27

Christmas House
(With Decorative Packaging)
$30.00 ea.

$

Subtotal:____________________________

~ VALENTINE’S DAY CHOCOLATES ~

No.
Description
Price
Quantity
Total Price

28

Milk Chocolate Heart Novelty
(2 oz. each)
$2.25 ea.

$

29

Heart Shaped Lollipops
(2 oz. each)
$2.50 ea.

$

30

Solid Hearts
(4 oz. Bag)
$3.25 ea.

$

31

Solid Hearts in Gift Box
(6 oz.)

$3.75 ea.

$

32

Peanut Butter Hearts
(4 oz. Bag)
$5.75 ea.

$

33

Peanut Butter Hearts in Gift Box
(6 oz. Box)
$8.50 ea.

$

34

Novelties in Favor Box
(1 oz.)

$1.75 ea.

$

35

Milk Chocolate Miniatures
(4 oz. Box)

$3.75 ea.

$

36

Sponge Candy
(6 oz. Box)
$6.75 ea.

$

37

Milk Chocolate Heart Box filled with
Foiled Hearts (11 oz.)
$7.50 ea.

$

38

Chocolate Caramel Apple with Nuts
and Valentine Decoratives (Approx. 20 oz.)
$15.00 ea.

$

Subtotal:____________________________

SHIPPING CHART:
Under $50.00 =
$9.95
$50 - $100.00 =
$17.95
$101 - $150.00 =
$25.95
Over $150 = $32.95

Shipping (from table above):_______________________

NY resident Add 8 % Sales Tax:___________________

TOTAL AMOUNT DUE:_____________________


Payment Method: ____Visa ____Mastercard ____Check ____Cash
(Please Check)

Credit Card#:________________________________ Exp. Date: _____ /_____

Check#_____________________________ Date of Check: _____/_____/_____

Signature_______________________________________________________