Chocolate Heart Order Form

Hi there, thanks for your interest in my homemade chocolates. Each chocolate heart is made with love ♥. Order some in time for Valentine's Day or as a special treat for someone who deserves it. A few things to note about these yummies:

Dark chocolate hearts are made with 60% dark chocolate, hazelnuts, and fresh blueberries. Milk chocolate hearts are made with milk chocolate, cinnamon, coconut, and pecans.

Chocolates contain milk products, hazelnuts or pecans, coconut. May have come in contact with peanuts.

Since these treats contain fresh ingredients without preservatives, it is best to store them in the fridge. Devour within 5 days (if you can wait that long).
Contact Info
Name *
Email Address *
Chocolate Selection
Chocolate type 1 *
Quantity *
Chocolate type 2
Chocolate type 3
Chocolate type 4
Delivery Date

Payments are cash only upon delivery. Please allow 2 business days for delivery. Chocolates will be delivered to you at the office by Nell Pimentel during regular work hours on the delivery date you specify.
Additional Notes
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy