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Product Order Form

Please use this form to submit a product order via web, filling in as much detail as possible. Be sure to provide us with a contact name and phone number as we may need to clarify your order.

Contact Information:

Name Pickup date / Date Required
E-mail
Phone  

Product Order

Quantity
(incl. units)		 Description Price

Method of Delivery:

Ship to: Pick-up

 

please include full shipping address:

please indicate which of our retail stores you will be picking up your order from:

Method of Payment:

visa Visa mastercardMastercard In-store Payment (Cash, Debit)
Please contact us at (604) 437-8221 to provide your credit card information during regular business hours (orders will not be processed until payment information has been received).

    

Alternatively, if you wish to use your own e-mail program to send us an e-mail, please contact us at charlieschocolatefactory@telus.net