Chocolate Sales Payment & Order Form
Thank you for your support of Regina Elementary Chocolate Sales! Proceeds from these sales go to fund the Home & School budget that directly gives back to our Regina students and teachers. Please note: A separate form should be used and submitted for each child so that sales credit can be recorded for each individual student's recognition package. All new chocolate requests submitted by 7:00 am will be fulfilled same-day. Anything submitted after 7:00 am will be fulfilled the following day.
Student Name
*
First Name
Last Name
Student Grade Level
*
Please Select
Kindergarten
1st
2nd
3rd
4th
5th
6th
Teacher Name
*
Parent Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
What would you like to do today?
*
Place a New Order that I will pick up before school.
Place a New Order to send home with my student.
No Order. Make a payment for previously received cases.
Payment Mode
*
I will pay online now with credit card.
I will pay later with cash, check or credit card.
I would like to order Additional cases of Variety Chocolate Bars
Please Select
1 extra case ($60.00)
2 extra cases ($120.00)
3 extra cases ($180.00)
4 extra cases ($240.00)
Please select the number of extra cases of chocolate bars you wish to order.
I would like to order Additional cases of Caramel Chocolate Bars
Please Select
1 extra case ($60.00)
2 extra cases ($120.00)
3 extra cases ($180.00)
4 extra cases ($240.00)
Please select the number of extra cases of chocolate bars you wish to order.
I would like to order Additional cases of Mint Meltaways.
Please Select
1 extra case ($60.00)
2 extra cases ($120.00)
3 extra cases ($180.00)
4 extra cases ($240.00)
Please select the number of cases of Mint Meltaways you wish to order.
Items I would like to Pay for and/or Order today. PLEASE NOTE: you only need to select the option that meets your need. If ordering you must select the quantity of cases.
prev
next
( X )
Payment ONLY for the INITIAL 2 Cases of Variety Chocolate Bars
$
120.00
Cost of 2 Cases of Variety Chocolate Bars ($60/case)
Payment ONLY for PREVIOUSLY Ordered ADDITIONAL Cases of Variety Chocolate Bars, Carmel Bars, or Mints
$
60.00
This is for cases of chocolate beyond the 2 original cases that you have PREVIOUSLY ordered and already received before today. Cost is $60/case of Chocolate Bars, Carmel Bars or Mints. Please select the number of cases you are paying for.
Quantity
1
2
3
4
5
6
NEW Order & Pay now for ADDITIONAL Cases of Variety Chocolate Bars
$
60.00
A full case of Variety Chocolate Bars includes 30 bars in a variety of flavors including: (Almond, Caramel, Crisp, Wafer, Milk Chocolate, and Dark Chocolate). Please select the quantity of cases you would like. Cost is $60/case.
Quantity
1
2
3
4
Item subtotal:
$
0.00
NEW Order and Pay now for ADDITIONAL Cases of CARAMEL Bars
$
60.00
A full case of CARAMEL only candy bars, includes 30 bars in caramel flavor. Please select the quantity of cases you would like. Cost is $60/case.
Quantity
1
2
3
4
Item subtotal:
$
0.00
NEW Order & Pay now for ADDITIONAL Cases of Mint Meltaways
$
60.00
A full case = 20 individual boxes of Mint Meltaways. Please select the quantity of cases you would like. Cost is $60/case.
Quantity
1
2
3
4
Item subtotal:
$
0.00
DONATION TO COVER CREDIT CARD PROCESSING FEES
$
2.00
I would like to donate $2.00 per case of chocolate ordered to help cover the credit card processing fees that Home & School incurs to offer the convenience of credit card payment.
Total Quantity of Cases Ordered
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Item subtotal:
$
0.00
Total
$
0.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Submit
Should be Empty: