Belgian Chocolate
For Chocolate Fountains
Order Form
          

 We Sell Chocolate Order Form 

                                # of Tubs       $20 per Tub      Total 

Milk                                                                                                   
                                                                                      
Semi Sweet                                                                                     
                                                                    
White                                                                                               
                                                                                               
       
Subtotal                                                    ________________

VA residents add 5% Sales Tax         ________________

Flat Rate Shipping                                  $9.95

                                     TOTAL                        ____________        
              
                           
Please make your check payable to:
  Capitol Chocolate Fountains
11510 Robertson Drive
Hornbaker Business Park
Manassas, Virginia 20109


Questions?
Call us at (703) 369-7378
or Toll Free at
1 877 246-2386 


Print out form and mail to above address
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