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Membership Form




Your Name
 

Your Address
 

Your Post Code
 

Your Phone Number
 

Your Email Address
   

I would like to become a member of The Chocolate Club for
3 Months for £45.00 (3 x box of 12 chocolates, including delivery)
6 Months for £75.00 (1 month Free) (6 x box of 12 chocolates, including delivery)
12 months for £150.00 (2 months Free) (12 x box of 12 chocolates, including delivery)

Please specify your start delivery date for your chocolates using the calender below:

< September 2010 >
Mon	Tue	Wed	Thu	Fri	Sat	Sun
30	31	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	1	2	3
4	5	6	7	8	9	10

Please complete the following section if you would like to send chocolates to  friends / family on specified dates.
How Many Friends?

None
1
2
3


I agree to inform CHOCOLATE HOUSE of any changes to the above details i.e. postal address etc before the date specified for delivery.

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