Lolli's Chocolates of Lafayette
Valentine's Day Order Form
Name
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First Name
Last Name
Email
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example@example.com
Phone Number
*
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Area Code
Phone Number
Appointment
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My Products
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Love Basket
$
23.00
Heart Basket includes chocolate covered pretzels, oreos,peanut butter cookies, chocolate chip cookies, graham crackers, a rice krispie treat, a caramel pecan turtle, a marshmallow, and a solid chocolate heart lollipop!
Quantity
1
2
3
4
5
Item subtotal:
$
0.00
Heart Basket
$
23.00
Heart Basket includes chocolate covered pretzels, oreos,peanut butter cookies, chocolate chip cookies, graham crackers, a rice krispie treat, a caramel pecan turtle, a marshmallow, and a solid chocolate heart lollipop!
Quantity
1
2
3
4
5
Item subtotal:
$
0.00
LOVE MUG
$
20.00
LOVE Mug includes chocolate covered pretzels, oreos,peanut butter cookies, chocolate chip cookies, graham crackers, a caramel pecan turtle, and a solid chocolate heart lollipop!
Quantity
1
Item subtotal:
$
0.00
HAPPY VALENTINES DAY MUG
$
20.00
Happy Valentines Day mug includes chocolate covered pretzels, oreos,peanut butter cookies, chocolate chip cookies, graham crackers, a caramel pecan turtle, and a solid chocolate heart lollipop!
Quantity
1
Item subtotal:
$
0.00
Two Of a Kind Basket
$
26.00
A basket to share with your sweetheart includes two pecan caramel turtles, two packs of two chocolate covered oreos, two packs of two chocolate covered pretzels, two packs of two peanut butter cookies, two brownies, two s'mores and two solid chocolate hearts!
Quantity
1
2
3
4
5
Item subtotal:
$
0.00
Heart Paperboard Basket
$
16.00
Baskets include individually wrapped chocolates such as pretzels, Oreos, peanut butter cookies, graham crackers, chocolate chip cookies, brownie, and a chocolate heart sucker!
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Chocolate Caramel Apple
$
8.00
Type
Quantity
Flavor
Price
Plain Chocolate Caramel Apple
1
2
3
4
5
6
7
8
9
10
Milk Chocolate Caramel Apple
White Chocolate Caramel Apple
$
8.00
Fancy Apple with Pecans
1
2
3
4
5
6
7
8
9
10
Milk Chocolate Caramel Apple
White Chocolate Caramel Apple
$
9.00
Item subtotal:
$
0.00
Valentine’s Variety Pack
$
10.00
Valentine's Day pack includes wrapped Oreos, pretzels, brownie bite and graham cracker, and a chocolate heart!!
Quantity
1
2
3
4
5
6
7
8
9
10
Turtle Box
$
12.99
6 Caramel Pecan Turtles
Quantity
1
2
Flavors
Milk
Mixed
Variety Boxes
$
24.00
Gift box all dipped with Heart Pretzels, Pretzel Rods, Pecan Clusters,Chocolate Chip, Oreo, and Peanut Butter Cookies all dipped in chocolate
Size
Quantity
Price
Large 30 pieces
1
2
3
4
5
6
7
8
9
10
$
24.00
Item subtotal:
$
0.00
Chocolate Covered Pretzels
$
4.00
4 Pack of pretzels wrapped with a bow.
Flavor
Quantity
MIlk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Milk/White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Chocolate Covered Oreos
$
4.00
4pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Milk/White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Brownie Bite
$
1.75
1pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Heavenly Hash
$
3.00
1pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Graham Cracker
$
1.75
1pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Marshmallow
$
1.75
1pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Rice Krispie Treats
$
2.00
1pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
S'more
$
2.25
1pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
White
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Dark
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Item subtotal:
$
0.00
Caramel Pretzel Sticks
$
4.00
2 pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
White
1
2
3
4
5
6
7
8
9
10
Dark
1
2
3
4
5
6
7
8
9
10
Milk/White
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Caramel Pecan Pretzel Sticks
$
5.00
2pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
White
1
2
3
4
5
6
7
8
9
10
Dark
1
2
3
4
5
6
7
8
9
10
Milk/White
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Sea Salt Caramels
$
3.50
2pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
Dark
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Chocolate Peanut Butter Cookies
$
4.00
4 pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
White
1
2
3
4
5
6
7
8
9
10
Dark
1
2
3
4
5
6
7
8
9
10
Milk/White
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Pecan Caramel Turtles
$
4.00
2pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
Dark
1
2
3
4
5
6
7
8
9
10
Milk/White
1
2
3
4
5
6
7
8
9
10
White
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Pecan Clusters
$
5.00
5pk
Flavor
Quantity
Milk
1
2
3
4
5
6
7
8
9
10
White
1
2
3
4
5
6
7
8
9
10
Dark
1
2
3
4
5
6
7
8
9
10
Milk/White
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Almond Clusters
$
5.00
5pk
Quantity
1
2
3
4
5
6
7
8
9
10
Flavor
Milk
Dark
Chocolate Covered Strawberries
$
12.00
Strawberries are made to order daily. We recommend gifting strawberries the same day as pickup or refrigerate for the next day! Chocolate Covered Strawberries are offered in White, Milk, or Dark chocolate.
Size
Flavor
Quantity
Price
6 strawberries
Milk
White
Dark
Milk/White
Milk/Dark
Mixed (milk, white, dark)
1
2
3
4
5
6
7
8
9
10
$
12.00
12 strawberries
Milk
White
Dark
Milk/White
Milk/Dark
Mixed (milk, white, dark)
1
2
3
4
5
6
7
8
9
10
$
24.00
Item subtotal:
$
0.00
Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Payment Methods
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Please click one of the PayPal options to complete payment and
submit
the form.
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