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Chocolate Indulgence |
Gifts for the Special People in Your Life |
To Order
If you are paying by check or money order--or--you are not comfortable leaving your credit card number on the web, use the following method for ordering:
1. Print out this file.
2. Fill in entire form.
3. Mail with check or money order as instructed below. If you are uncomfortable leaving
your credit card number on the internet, this form can also be used for credit card
orders.
4. Checks will be held for clearance.
5. Shipment times will vary with products ordered.
6. All payments in US Funds. Shipments only within US at this time.
7. Only one order per form, please, because of gift card
and shipping information
Your name
_______________________________________________________
Your address ______________________________________________________
________________________________________________________________
Your email: _____________________________________________________
Your telephone number: (______) _____________________________ We must have your phone
number to process order. Your private information is never sold/shared in any manner.
| Description | Style | Price | $$$ Ordered | Shipping information: Please Print | |
| Chocolate Three Months | 10126 | $ 72.00 | $ | Recipient's Name: | |
| Chocolate Six Months | 10127 | $ 135.00 | $ | Recipient's Phone # ( ) | |
| Chocolate Twelve Months | 10128 | $ 260.00 | $ | Address: City/State/Zip: |
|
| Texas residents add 8.25% for sales tax | $ | ||||
| Shipping: UPS Ground | 3 months: $12.00 | $ | First Gift Card to Read: Please Print | ||
| 6 months: $24.00 | |||||
| 12 months: $48.00 | |||||
| Total due | $ | Consecutive
Gift Cards to Read: Please Print |
|||
| Description | Style | Price | $$$ Ordered | Shipping information: Please Print | |
| Chocolate Three Months | 10126 | $ 72.00 | $ | Recipient's Name: | |
| Chocolate Six Months | 10127 | $ 135.00 | $ | Recipient's Phone # ( ) | |
| Chocolate Twelve Months | 10128 | $ 260.00 | $ | Address: City/State/Zip: |
|
| Texas residents add 8.25% for sales tax | $ | ||||
| Shipping: UPS Ground | 3 months: $12.00 | $ | First Gift Card to Read: Please Print | ||
| 6 months: $24.00 | |||||
| 12 months: $48.00 | |||||
| Total due | $ | Consecutive
Gift Cards to Read: Please Print |
|||
| Description | Style | Price | $$$ Ordered | Shipping information: Please Print | |
| Chocolate Three Months | 10126 | $ 72.00 | $ | Recipient's Name: | |
| Chocolate Six Months | 10127 | $ 135.00 | $ | Recipient's Phone # ( ) | |
| Chocolate Twelve Months | 10128 | $ 260.00 | $ | Address: City/State/Zip: |
|
| Texas residents add 8.25% for sales tax | $ | ||||
| Shipping: UPS Ground | 3 months: $12.00 | $ | First Gift Card to Read: Please Print | ||
| 6 months: $24.00 | |||||
| 12 months: $48.00 | |||||
| Total due | $ | Consecutive
Gift Cards to Read: Please Print |
|||
Payment by ___ Check No. ______________
payable to CyberParent. All payments in US funds.
Payment by ___ Money Order payable to CyberParent. All payments in
US funds.
Payment by ___ Credit Card. Must fill in form below. All payments in US funds.
Mail order with payment to CyberParent. P O Box
610207, Dallas, TX 75261
Thank you for your order. Your card will be mailed immediately. First gift shipped within
two weeks. Consecutive gifts shipped right after first of each month.
Credit Card Authorization
I authorize CyberParent to charge my ___ MasterCard ___
Visa ___ American Express
Account number _____________________________ Amount: $_____________________.
Expires ______ / ______ / _______.
Signature:___________________________________ Date: ___________________
Please print:
Billing Name: __________________________________
Billing Address: ____________________________________________ Suite ____________
City, State, Zip: ____________________________________________________________
Copyright © 1997-2011 CyberParent, LLC. All rights reserved.
Note: The opinions expressed herein are exclusively those of the writers or other participants and do not necessarily reflect the position of CyberParent, LLC. They are not intended to take the place of advice from a health, legal, or other professional whose expertise you might need to seek.