Fax to Lee Sims Chocolates - 201-433-0288
 this form is for single item orders to multiple addresses
for multiple item orders forms  click here.

buyer

 (my name)

company:

 (if needed)

street:

ofc/suite

city:

 st zip

phone:

 (required)

email:

 (please)

call between and (please provide as wide a time range as possible)
#1 qtyitem@ #2 qtyitem@

person:

person:

company:

 company:

street:

street:

city:

 city:

state

 zipphn# state zipphn#

message

 message

ship to arrive on or before (date)

ship to arrive on or before (date)

#3 qtyitem@ #4 qtyitem@

person:

person:

company:

 company:

street:

street:

city:

 city:

state

 zipphn# state zipphn#

message

 message

ship to arrive on or before (date)

ship to arrive on or before (date)

#5 qtyitem@ #6 qtyitem@

person:

person:

company:

 company:

street:

street:

city:

 city:

state

 zipphn# state zipphn#

message

 message

ship to arrive on or before (date)

ship to arrive on or before (date)