~ 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 (PCs= pieces) and total price for each item desired:

No.

Description

Price

Quantity

Total Price

1

Seasonal Lollipops
(approx. 3 oz. ea.)
$2.00 ea.
PCs
$

2

Dipped Pretzel
(Caramel/Pecan/Milk Chocolate 3 oz.)
$2.50 ea.
PCs
$

3

Milk Chocolate Dipped Miniature Biscotti
(7 oz. Bag)
$7.00 ea.
PCs
$

4

Milk Chocolate Dipped Large Biscotti
(7 oz. Bag)
$7.00 ea.
PCs
$

5

Milk Chocolate Covered Oreos®
$7.00 ea.
PCs
$

6

Heavenly Mix
(3 oz. Gold Foiled Box)
$4.00 ea.
PCs
$

7

Heavenly Mix
(6 oz.)Please check one:

Seasonal Bag:_____________

Gold Striped Bag:___________
$5.00 ea.
______ PCs

______ PCs
$_____

$_____

8

Heavenly Mix
(12 oz. Clear Bag)

$8.00 ea.
PCs
$

9

Heavenly Mix
(1 lb. Silver-Striped Bag)

$10.00 ea.
PCs
$

10

Chocolate Caramel Apple
(WITH Nuts approximately 20 oz.)

Seasonal Decorative pkg._______

$12.00 ea.
$13.00 ea.
PCs
$

11

Chocolate Caramel Apple
(NO Nuts approximately 20 oz.)

Seasonal Decorative pkg._______
$12.00 ea.
$13.00 ea.
PCs
$

12

Traditional Mixed Roasted Nuts
(Premium Quality, Peanut Free, 15 oz. Bag)
$10.00 ea.
PCs
$

13

Milk Chocolate Sponge Candy
(4 oz. Bag)
$4.00 ea.
PCs
$

14

Milk Chocolate Peanut Butter Novelties
(7 oz. Seasonal Bag)
$7.50 ea.
PCs
$

15

Milk Chocolate Caramel Pecan Patties
(6 oz. Elegantly Boxed)
$7.50 ea.
PCs
$

16

Milk Chocolate Nut Bark
(7 oz. Bag)

$7.50 ea.
PCs
$

17

Milk Chocolate Covered Popcorn (3 oz. Bag)

$4.00 ea.
PCs
$

18

Milk Chocolate Covered Popcorn
(6 oz. Bag)

$7.00 ea.
PCs
$

19

Milk Chocolate Peanut Clusters
(7 oz. Boxed)

$7.50 ea.
PCs
$

20

Milk Chocolate Raisin Clusters
(7 oz. Bag)

$7.50 ea.
PCs
$

21

Milk Chocolate Coconut Clusters
(7 oz. boxed)

$7.50 ea.
PCs
$

22

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

23

Special Orders
(Additional items available on request.)
$
PCs
$

24

 Gingerbread Tree Cookie
(White & Milk Chocolate individually wrapped)
$3.50 ea.
PCs
$

25

Dark Chocolate Laced Candy Cane
$3.50 ea.
PCs
$

26

Dark Chocolate Coconut Macaroons
(7 oz. Bag)
$7.00 ea.
PCs
$

27

Christmas House
$30.00 ea.
PCs
$

Subtotal:____________________________

SHIPPING CHART:
Under $20.00=
$5.95
$75.01-$100.00=
$22.95
$20.01-$35.00=
$8.95
$100.01-$150.00=
$28.95
$35.01-$55.00=
$11.95
$150.01-$200.00=
$34.95
$55.01-$75.01=
$17.95
Over $200.00=
add 18% of total cost

Shipping/Delivery:_______________________

NY resident Add 7% Sales Tax:___________________

TOTAL AMOUNT DUE:_____________________


Payment Method: ____Visa ____Mastercard ____Check ____Cash
(Please Check)

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

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

Signature_______________________________________________________