---------------------------------------------------------------
Your Name (person or persons ordering):___________________________________________
Full Address:________________________________________________________________
Phone Number:_______________________________________(In case of a question)
E-mail address:_____________________ Payment method: __Check __Money order___Cash (in person)
Name of Whom the Bar is for:___________________________________________________________
Significance of date (Birthday, Anniversary etc.)___________________________________________
Special Date:__________________________________________
Relationship to person receiving bar: ______________________________________________
What would you like to have said on the bar (exactly)?
Front:____________________________________________________________________
Back:_______________________________________________________________________
Wrapper Style: ______________(if not chosen we will choose one for you)
Over 150 wrappers to choose from check out the Product Catalog. Orders include a full size personalized chocolate bar, decorated envelope, postage and all taxes. All for $5.00 each. ( $7.00 for US orders). PLEASE FILL OUT ONE FORM FOR EACH ORDER. All orders will be mailed out 7 days in advance unless out of province. Mail your order forms and payment to:
Message On A Wrapper
Rosemary Glavin/June Glavin
104 Devon Drive
Exeter, Ontario, NOM 1S3
Ph. 519-235-2284 or Fax 519-228-6534