Document 6485977

CANDY BOUQUET ORDER FORM
ALL PROCEEDS BENEFIT RELAY FOR LIFE!
Name ______________________________________
Contact Number _____________________
Order Date ________________________________
Completion Date ____________________
This Bouquet is for (circle one)
Please circle size of bouquet
boy
girl
Small $12
woman
man
Medium $18
Large $24
XLarge $30
Small will include approx. 6 large candy bars; Medium will include a mixture of
small and large candy as well as a base candy; Large will include a very full variety
of small and large as well as a base candy and filler (example is skittles above);
XLarge will include large variety of everything plus an edible base and will be
plenty to share!
Please specify color preference if any _____________________________________________________
Please specify theme if any _________________________________________________________________
Please circle atleast 3 types of candy you would like in your bouquet- you may circle
as many as you’d like
Snickers
Reeses
M&Ms
KitKat
Hersheys
Skittles
Almond Joy
Mounds
Twix
Baby Ruth
Milky Way
3 Musketeers
Butterfinger Tootsie Rolls Gum
DumDums
AirHeads
Starburst
OTHER: _______________________________________________________________________________________
I prefer (circle one)
miniature candy
full size candy
mixture
Specific Dislike _______________________________________________________________________________
Add A Card $1 to read _______________________________________________________________________
We can add anything you’d like to your bouquet to make it more unique! There is an
additional charge unless you provide item! Some examples include matchbox cars,
Barbie doll, movie tickets, gift cards etc. Be creative!
Custom Notes: _______________________________________________________________________________
We look forward to creating this especially for you! All proceeds will benefit the
American Cancer Society Relay For Life. Please make checks payable to
American Cancer Society or ACS. Return this order form along with payment to:
Michelle Linkous -1330 Huffville Rd. Pilot, VA 24138. 540.239.3747