E& A Candies  
   
         

E & A Candies
414 Deim Woods Drive
New Holland, PA 17557

Fax: 717-355-0065
Phone: 717-355-0065 or 301-421-4244
E-mail: EACandies@BurtonsvilleDutchMarket.com

To order you can call or visit us or fill out the following order form.

Chocolates  

Order Form
1. Print out this form. 2. fill it out (please type or print clearly)
3. Mail it to us at the address given above or fax it to the number above.

Description
Quantity
Unit Price
Amount
       
       
       
       
       
       
       
       
       
       
       

Check / Money Order Enclosed
Phone Order 717-355-0065 or 301-421-4244
Credit Card:
(circle one) Visa, MasterCard, Discover
Card Number: _______ _______ _______ _______
Expiration Date: ____________________________
V-Code: _______(3 digit security number)

Signature: _____________________________________

Cost of Candy $
 
Shipping / Handling Charge $
$10.00 for 1-5lb, each additional pound add $0.75
 
Total: $
 

Ship My Candy to:

Name: ________________________________________ City: _____________________State: _____ Zip: ___________

Address: ________________________________________________________________________________________

Receiving Date Desired: __________________________ Phone: ____________________________________________

thank you for your order!
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