Edible Image (Chocolography) Order Form

Date your order is needed:           

BILLING ADDRESS

Name:           

Company:

(if applicable)

Address:           

City:      State:     Zip:

Daytime Phone:   Evening Phone:

Email Address:

SHIPPING ADDRESS     Check here if same as Billing Address

Name:

Company :

(if applicable)

Address:

City:     State:     Zip:

PAYMENT

Payment is due once you receive your invoice.  You will receive an invoice from us with a link to our payment site.  We accept Visa, MasterCard, Discover & American Express through Paypal.  Checks and money orders are also accepted.  Payments made by check will add an extra five to seven day wait period before the product will be processed.

PERSONALIZATION

Choose a Product:            Please select Item 114 - Clam Shell Round Lollipop - $3.25 Item 115 - Heart Lollipop - Cellophane - $3.25 Item 116 - Six Star Lollipop - Cellophane - $3.25 Item 105 - Deluxe Round Lollipop - $4.00 Item 106 - Deluxe Heart Lollipop - $4.00 Item 107 - Deluxe Six Star Lollipop - $4.00 Item 108 - Deluxe Oval Lollipop - $4.00 Item 130 - Deluxe Chocolate CD - $6.50 Item 135 - Deluxe Square CD - $8.00 Item 202 - Candy CD - $5.00 Item 205G - Round Party Favor Gold - $4.50 Item 205S - Round Party Favor Silver - $4.50 Item 206G - Heart Party Favor Gold - $4.50 Item 206S - Heart Party Favor Silver - $4.50 Item 207G - Six Star Party Favor Gold - $4.50 Item 207S - Six Star Party Favor Silver - $4.50 Item 208G - Square Party Favor Gold - $4.50 Item 208S - Square Party Favor Silver - $4.50 Item 201 - Business Card - $3.00

Text on Favor (Keep in mind there is limited space.)

PHOTO

Once you have entered the information and click the submit button, you can email your picture to us. 

Quantity:  

How did you hear about us?

Please select:            Please Select Flyer or Mailer Friend/Referral Returning Customer Google Yahoo Other Search Engine Other