Company Name:				Telephone:
Street:				Fax:
City:		State/Province:		Email:
Country:		Postal/Zip Code:		Web Address:

Contact Information

First Name:		Last Name:
Title:		Email:

Candy you offer...

Non-chocolate Candies...
Bulk, Branded, Non-chocolate			Bulk, Non-branded, Non-Chocolate
Candy Canes	Caramels	Fruit Chews	Fruit and Nuts		Fudge
Gift Baskets	Gummies	Gums/Jellies	Gum	Hard Candy
Holiday/Seasonal		Jelly Beans	Licorice	Marshmallow	Mints
Novelty	Organic	Suckers	Sugar Free	Taffy	Toffee
Wafers

Chocolate Candies...
Bar	Boxed	Bulk, Branded	Bulk, Non-brand		Fat Free
Foiled	Gift Sets	Hollow	Malted Milk Balls		Marshmallow
Milk Chocolate		Moulded	Nougats	Nuts	Panned
Solid	Sugar Free	Truffles	Wafers	Holiday/Seasonal

Platinum service required for the following categories...
Contract Manufacturing	Corporate Gifts	FundRaising

Service Packages,

	Platinum Package:$45.00/year
	Includes company name, address, discription, logo/image, phone, fax, email and a web link directly to your company web page.
	Supplier Package: $45.00/year
	Complete listing with web and e-mail links. Requirements will be E-mailed.

Purchase Order Number:

* A purchase order number must be provided for Platinum and Supplier service packages.