Roxboro Elementary Chocolate Sale Online Order Form
How it works
See the main page for details on how the Chocolate Sale works. Use this form to order as many boxes as you choose. You have two payment options, either pay online using this page, or send cash/check with your child. Either way, you need to fill out this form so we have your info.
Student Name *
Your answer
Student Grade *
Teacher's Name *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number (Include Area Code) *
(555) 555-5555
Your answer
Parent/Guardian Email *
Your answer
Preferred Method of Contact
Number of Boxes *
This is a:
Send with my child or donate to City Mission?
Pay now or pay later? (All payments due by September 28.) *
If paying now, how will you be paying? *
Next steps
Be sure to click "submit" to record your info for our records. If paying online now, you should then click the "ad to cart" button below. You should be taken to a PayPal page that will show the number of boxes you requested, and where you can pay with PayPal or credit card.
Submit
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