Easter Order Form

Jagielky's Easter Order Form

Ventnor, NJ * Margate, NJ (609) 823-6501
ATTENTION!: WE ARE NO LONGER ACCEPTING ONLINE ORDERS. PLEASE CALL US AT 609-823-6501 (Ventnor) or 609-822-2204 (Margate). Effective immediately.

How this works: This is just for Easter Egg - Easter Candy Orders. Complete the billing and general order form details below, then tell us what you'd like, and where you'd like this shipped (not required for pick up). When we receive your order, we will call within 24-48 hours to confirm all the information and then collect your billing information.

NOTE: It's best to pre-order your eggs! The popular eggs sell out quickly and we cannot guarantee we'll have what you want during the week before Easter.

Please note: Shipping to hot locations such as CA, NV, FL will incur an additional $11 for chill box and overnight shipping fees (Approximately $70 in addition to chill box; we want your chocolate to arrive safely, and not melt). We do not ship internationally. We do not do personal deliveries, shipping only.
You can upload your list as long as it is in pdf (adobe acrobat) form, and has your name and phone number on it. If you chose this method, please fill out the section below for pickup or shipping and email, and the shipping / billing info at the bottom.

Upload a File

Cancelof
Pickup or Shipping?*

Pickup at MargatePickup at VentnorShipping
Pickup Date or Receive by Date:*
E-mail (for order confirmation)*
----------- For Easter Egg Orders --------------

How to order: Select the size of egg, the type of chocolate, the type of egg filling, and then quantity. You'll have a place for names. After completing your egg orders, you will be given the opportunity to order the other Easter candy.

If you don't want eggs, but want easter candy, click no for the more eggs question, then click yes and next button. If you want a basket made, make your selections, and include instructions when you get to the shipping and billing page.
Selection 1:
Size of Egg
Type of Chocolate
Filling
Quantity
Names to go on Eggs
What message on the card to the recipient?
Have more eggs to order?

YesNo
Want to order other Easter Candy?

YesNo

Selection 2:
Size of Egg
Type of Chocolate
Filling
Quantity
Names to go on Eggs
What message on the card to the recipient?
Have more eggs to order?

YesNo
Want to order other Easter Candy?

YesNo

Selection 3:
Size of Egg
Type of Chocolate
Filling
Quantity
Names to go on Eggs
What message on the card to the recipient?
Have more eggs to order?

Yes (you'll be taken to a different page to type in remainder of order)No
Want to order other Easter Candy?

YesNo

Other Candy Section: Other Easter Candy. All 1/2 pound unless otherwise marked. Please list in the box below how many of what kinds you would like.

Mixed Jelly Beans	Licorice Jelly Beans	Gourmet Jelly Beans
Gourmet Mix	Peanut Butter Bunnies	Caramel Bunnies
Coconut Cream Eggs	Milk Foil Eggs	Dark Foil Eggs
2oz Milk Bunny	2oz Dark Bunny	2oz White Bunny
6oz Milk Bunny	6oz Dark Bunny	6oz White Bunny
12oz Milk Bunny	12oz Dark Bunny	12oz White Bunny
Milk Covered Peeps	Dark Covered Peeps	Carmello Eggs M/D

Please list out how many of what you'd like. If you don't see something you'd like, write it in and we will confirm selections with you.

Additional Requests: In the box below, you can tell us everything else you'd like, in lieu of the above or in addition to the above. This includes gift boxes, baskets, etc. Make sure to include quantity / amount, type of chocolate. We will be calling you to review this complete order form.
Did you miss the Order Other Easter Candy Section? (if yes, hit the back button below)

YesNo
How would you like this packaged?*

In a basketAs a TowerAs it comes, no special directionsOther
What else would you like in addition to the above, or instead of the above?
Additional Requests, Notes, or Comments

Please enter Shipping information below if this is not a pick-up. Please note: make sure you have the correct Apt. # and other identifying information like floor number and business name if applicable. If this is being sent to a college or a camp, please make sure to inform the party it's coming so they can look out for it or inform the right person. If you do not see shipping fields below, check above that you did select shipping.
Is shipping address:

a Residencean Apartment (please include apt # and floor)a Business
Shipping to: Full Name

First NameLast Name
Business Name
Phone Number (recipient)

Area CodePhone Number
Shipping Adress

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Full Name for Billing*

First NameMiddle NameLast Name
Contact Number (to confirm order and billing)*

Area CodePhone Number
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please review and confirm your order. We will contact you within 24 hours of receipt of this order. Please note, on weekends and busy holiday periods, it may take longer to contact you. If we cannot reach you via phone, we will email you.
I confirm I have reviewed this order.*

Yes, I have reviewed this order
To prove you're a human, Enter the message as it's shown*
Should be Empty:

Jagielky's Easter Order Form