Swiss chocolate by Boehms Chocolates

Order Form

You can order with your credit card
By phone (206) 243-2027
By fax (206) 243-3091
By mail to - Boehms Chocolates Burien
148 SW 148th St., Suite B120
Seattle, WA 98166

To order by fax or mail, please print out the order form on your printer. Complete all the information below from the items you select from our products page. For more instructions, see our Ordering Information.

Ship To:		Credit Card Type:
Name:		MC Visa Discover AMX
Address:		Expiration Date:
City:		Credit Card # :
State:	Zip:
Shipping:
Standard (Cool weather only) Next Day Air		____________________________
Priority 2nd day Ice Pack		Signature
$3.00 Gift Wrapping:		________________________________
Yes No		Print Name
Gift Card Message:		Email:
		Phone: Fax:

Place Your Order Below
Item Description	Size	Quantity	Price	Total






Subtotal:
Dollar Amount	Standard 2-5 days (Cool weather only)	Priority 2nd day	Next Day Air
Up to $1.00 - $36.94	9.95	15.95	28.95
Up to $36.95 - $51.94	12.95	17.95	30.95
Up to $51.95 - $66.94	14.95	19.95	32.95
Up to $66.95 - $81.94	16.95	21.95	34.95
Up to $81.95 - $96.94	18.95	23.95	36.95
Up to $96.95 - $110.00	21.95	25.95	38.95
Above $110.00	For every $15.00 over $110.00 Add $5.00
Add $4.50 for Ice Pack Each Address
International/Canadian Express Mail, $32.95 Approx. 3 Days NO GUARANTEE
Hawaii & Alaska Must Ship 2nd Day Air 2nd Day Air $29.95 Next Day $37.95 �
			Total
Boehms Chocolates Burien No returns, exchanges or refunds on all merchandise.

Fill this form and fax your order to (206) 243-3091
or call (206) 243-2027.

Boehms Chocolates Burien
148 S.W. 148th St., Suite B120, Seattle, WA 98166
Phone (206) 243-2027 • FAX (206) 243-3091

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