Contact Us – The Chocolate Chick

Contact Form

* indicates required field

Name:

Mailing Address:

Email:

Daytime Phone:

Evening Phone:

Day of Event Cell Phone:

Company Name (If Applicable)

Title:

Your Event Date: (Format as month/day/year)

Time of Your Event: (Indicate AM or PM)

Event Location Street Address

Event City:

Event State:

Event Zip Code:

Location Within The Facility:

Are You Interested In Our Providing The Dipping Items:

Would You Like Information On Our Candy Buffets?

Caterer:

Caterer Phone:

Caterer Email:

Event Planner Name/Planner:

Planner Email:

Planner Phone:

What Type Of Event Are You Planning?

Color Scheme/Theme:

Approximate Headcount:

# Of Hours Fountain Needed:

Desired Type Of Chocolate Or Dessert Station:

Fountain Size Desired:

How Did You Hear About Us:

Message:*