Valentine's Order Form - Special Gifts made by Special People
Customer Name:
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Date:
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Address:
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Order for:
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Deliver to:
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Phone Number:
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What to put on card:
Delivery directions:
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Please check the box of the item that is being ordered.
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Coke Basket: 3 Drinks, 3 Candy Bars, 1 Cracker, and 1 of your choice: chips, peanuts or cookies $15.00
Popcorn Basket: 1 Drink, 3 Candy Bars, 1 Cracker, and 1 of your choice: chips, peanuts or cookies $15.00
Coke Bag: Coke, Chip, 1 Candy Bar $6.00
Small Strawberry bowl/box: 6 Strawberries (dipped)* $10.00
Large Strawberry box: 12 Strawberries (dipped)* $20.00
*these orders have to be placed by February 11th
How many LATEX balloons (various colors) do you want added to order? $1.00 ea.
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How many MYLAR balloons (various colors) do you want added to order? $2.00 ea.
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Delivery Charge: $1.00 in town, $2.00 out of town
$1.00
$2.00
Total:
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Form does not auto-calculate, please enter total.
Please leave a comment below if there is any diet restrictions for the order i.e.: Diabetic or Food Allergies
Please check the box for the items wanted for the following gifts.
Coke Basket: 3 Drinks, 3 Candy Bars, 1 Cracker, and 1 of your choice: chips, peanuts or cookies. Popcorn Basket: 1 Drink, 3 Candy Bars, 1 Cracker, and 1 of your choice: chips, peanuts or cookies. Drink Bag: 1 Drink, 1 Candy Bar.
Candy Bars
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Hershey
Hershey Almond
Kit Kat
Reeces
M&M Milk Chocolate
M&M Peanut
Butterfinger
Crunch
Baby Ruth
100 Grand
Original Skittles
Tropical Skittles
Wild Berry Skittles
Sour Skittles
Starburst Tropical Fruit
Starburst Original Flavor
Mr. Goodbar
Snickers
3 Musketeers
Twix
Milky Way
Crackers
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Cheese Crackers with Peanut Butter
Toasty Crackers with Peanut Butter
Cheese Crackers with Cheddar Cheese
Choco Cremes Chocolate Cookies
Vanilla Creme Cookies
Lemon Ohs!
N/A
Drinks
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Dr. Pepper
Coke
Diet Coke
Sprite
Cookies
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Grandma Chocolate Chip Cookies
Grandma Peanut Butter Cookies
Peanuts
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Salted Cashews
Salted Peanuts
Honey Roasted
Chips
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Fritos
Lay's Classic
KC Masterpiece Bar-B-Q
Sour Cream & Onion
Doritos Cooler Ranch
Doritos Nacho Cheesier
Cheetos
Submit
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