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V Day -Form Fill

Section One

Pick your V-Day gram (fill out one form per recipient)

Oreo my Valentine?$2.00 2 oreo truffles

Quantity

Cupid box$2.00 1 truffle and 1 mini oreo cheesecake

Quantity

Custom Conversation Heart Cookie$4.00 Insert your custom message at the end of the form. Please limit it to 10 characters.

Quantity

True Love Box$4.00 3 Oreo truffles and 1 mini oreo cheesecake

Quantity

Sweetheart box$5.00 1 cookie and 1 oreo truffle

Quantity

Valentine Box$5.00 2 oreo truffles and 2 mini oreo cheeseckaes

Quantity

Crazy in Love Box$5.00 1 cookie and 1 mini oreo cheesecake

Quantity

Message on the cookie (Please limit to 10 characters)

Delivery or Pickup*

Delivery

Pickup

Total Cost $

Payment Method*

If these payment options are not available for you, please contact Daaniyaal at [insert email]

Venmo (@Illini-Thaakat)

Quickpay / zelle (nisaa.aleem@gmail.com)

Please provide your Venmo or Quickpay*

If you would like to add a short message please write it here

From:

To:

Q10

Your Name*

First Name

Q11

Your Name*

Last Name

Q12

Your Phone Number*

Phone Number

Q13

Your Email Address*

Q14

Recipient Name*

First Name

Q15

Recipient Name*

Last Name

Q16

Recipient Phone Number*

Phone Number

Q17

Delivery Address

Street Address

Q18

Delivery Address

Street Address Line 2

Q19

Delivery Address

City

Q20

Delivery Address

Zip Code