Todays Date Cust. Daytime Phone # Cust. Fax#
Customer Name Address
City State
MC/ VISA/ DISCOVER/AMEX NUMBER :
EXP DATE
Security code (located in the signature line last three numbers)
All information stays on your computer. We only get what you mail usAddress City State
# Lb's |
FUDGE DESCRIPTION |
PRICE @ $20 per Lb |
Peanut Butter Chocolate Fudge |
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Marshmellow Fudge |
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Pecan Fudge |
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Regular Fudge |
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Coconut Fudge |
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Peppermint Candy Fudge |
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Mocca Chocolate Fudge |
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Dark Chocolate Fudge |
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Rocky Road Fudge |
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Dark Mocca Fudge |
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Walnut Chocolate Fudge |
PLEASE ADD Between 2-6 pounds of fudge: Will cost $9.99 to send anywhere in the US. Between 7-12 pounds: Will cost $24.95 to send it anywhere in the US |
SUBTOTAL   |
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<------ Shipping & Handling   | ||
TOTAL   |
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  Make checks to:   Jimmy James Joshua, TX 76058 |