Sample Order form
Your organization earns 30% on each order!
Memories in Chocolate, Inc.
Hershey Kiss or Hug and Kiss Roses $2.25 each
(2 Hershey kisses designed to look like a rose bud)
| # of pink roses _______ | # of red roses ________ | Subtotal $_________ |
Ghirardelli sweetheart roses $2.75 each
(solid ½ oz. of chocolate wrapped in foil with a rose stem)
| # of pink roses _______ | # of red roses ________ | Subtotal $_________ |
Ghirardelli large roses $4.00 each
(Solid 1.3 – 1.5 oz. of chocolate in foil on a stick with leaves and floral tape)
| # of pink roses _______ | # of red roses ________ | Subtotal $_________ |
Add greenery and clear box to any rose order: $3.00 per box
| # of boxes _________ | Subtotal $ _________ |
You may elect a single rose or a combination of roses to put in clear plastic box.
Please attach a separate note with instructions i.e. box #1 -3 pink sweetheart roses, box #2 -6 red large roses, etc.
| Product | Price | Quantity Ordered | Subtotal |
| Sign language “I love you” pops | $1.25 | #______ | Subtotal $___________ |
| Fillagree Heart pop | $2.75 | #______ | Subtotal $___________ |
| Rose in Heart pop | $2.75 | #______ | Subtotal $___________ |
| Biscotti | $3.00 | #______ | Subtotal $___________ |
| Pretzel | $2.50 | #______ | Subtotal $___________ |
| Sweet Greeting Card | $5.00 | #______ | Subtotal $___________ |
| Bear in Heart pop | $2.75 | #______ | Subtotal $___________ |
# of yellow ____ # of red _____ #of white ____ # of chocolate ______ Subtotal $___________
Rose Bouquets:
Ghirardelli sweetheart bouquets in a basic vase with greenery
½ dozen $22.50 #_______ 1 dozen $40.00 #________ Subtotal $___________
Color choice: Red [] Pink []
Ghirardelli large roses in a basic vase with greenery
½ dozen $31.50 #_______ 1 dozen $55.50 #________ Subtotal $___________
Color choice: Red [] Pink []
Upgrade vase to a crystal vase Small $7 Large $12 Subtotal $___________
Total $_____________
| Student name | __________________________________________________________ |
| Homeroom teacher | __________________________________________________________ |
| Parent name | __________________________________________________________ |
| Phone # | __________________________________________________________ |
Please make sure to include contact information so we may contact you with questions about your order! If this a surprise please give us a contact number or e-mail address that is not used by the recipient!
All orders will be at school by April 1st for pickup. These items will melt if left in a closed car (or even an open car if it's warm), so please make sure you will be heading straight home with them. We are not responsible for melted items or lost items! Please use your discretion if sending this home with your child, especially if he or she walks or takes the bus! Absolutely no refunds or replacements will be given once the item is released to you or your child.