Bar/Bat Mitzvah Chocolate Wrapper Order Form

Contact Name:

Contact Email Address (e.g.: you@aol.com)
Your email address is never sold or rented!
 

When is the date of your event?
January February March April May June July August September October November December     1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31     2003 2004 2005

Manufacturing Name On Front of Wrapper (e.g.: Name ®)
(If Hebrew, please fax this form to 858-259-6789 with Hebrew lettering. Consult with your Rabbi if uncertain.)
English
 
Hebrew
 

First Name of Person:

Personalized Message Under White Area:
(No more than 50 characters)

Ingredients (e.g.: all natural, funny, and sarcastic boy/girl)
(Not more than 30 words)

Nutritional Facts (e.g.: serving size "1 great son")

% Daily Value (e.g.: "love 100%, fun 100%")
(No more than 5 lines)

Choice of Candy Bar:
Crunch Bar
Symphony Bar
Hershey's Bar

Check box when photo has been e-mailed with subject "Chocolate Wrapper for Last Name"