BALLOON CANDY GRAM ORDER FORM

(Please print clearly) Date of Order: ________________________

First Name of Recipient _____________________ Last Name:________________________

Mailing Address: _____________________________________________________________

City: ____________________________________ State: **__________ Zip: ______________

** We DO NOT ship to the following states: WA, OR, CA, AK, HI, MT, ID, NV,

UT, WY, AZ, NM, TX, OK, CO, NE, SD, ND

Balloon/Occasion: ____________________________________________________________

Delivery Date (must allow 4 days from date of order):____________________________

Message you would like printed on the candy bar wrapper:

(Front) _______________________________________________________________

(Back) _______________________________________________________________

How did you hear about the Balloon Candy Gram? _______________________________

Person Ordering: Name, Phone # and/or e-mail address in the event of a question (Required)

** Will not be responsible for errors if there is no phone# or email listed **

__________________________________________________________________________________________________________________________________________________________________________

Method of Payment: Check ______ Money Order _______ Cash (In Person) ______

Billing Address: _______________________________________________________________

City/Town: ______________________ State: __________ Zip Code: ____________

Please send order form & $14.75 payment made payable to “Sweet Expressions”

~ Sweet Expressions ~ 40 Woody Crest Drive ~ Pittsburgh, PA 15234 ~

Please contact Sweet Expressions with any questions: Phone 412.885.8055

www.sweet-expressions.net