Welcome To Pure Bliss Chocolate Fountain

*Required information
CLIENT INFORMATION
Your Name*:
Company Name:
Address:
City:
State:	Zip Code:
Main Phone Number:
Cell Phone Number:
Fax Number:
*Email Address:**
How did you find out about Pure Bliss Chocolate Fountains?

EVENT INFORMATION
Date of Event:
Day of the Week:
Fountain Start Time:
Scheduled End Time:
Type of Event:
Color Scheme:
Number of Guests:
Event Location:
Caterer or Location Contact:
Phone Number:
Cell Phone:
Email:

FOUNTAIN SELECTION
Type of Chocolate:	Dark Chocolate
	Milk Chocolate
	White Chocolate
Custom Color ($50.00 additional charge)

OPTIONAL ITEMS
Client requests Pure Bliss Chocolate Fountains to provide dipping items ($2.50 per guest):

Please choose five dipping items:	Strawberries*	Creme Puffs
	Butter Cookies	Donuts Holes
	Bananas	Caramel Squares
	Pretzels	Croissants
	Apples	Chocolate Chip Cookies
	Marshmallows	Grapes
	Angel Food Cake	Biscotti
	Rice Krispie Treats	Pineapple
	* Strawberries available when in season.

PACKAGE SELECTION
Package:
Number of Guests for Dipping Items ($2.50 per person):
Travel Charge for Riverside, Los Angeles, or San Diego County:
Overtime ($50 1/2 hour):
Extra Chocolate Charge for Number of Guests Over 200 ($.50 per guest):

Please Enter Any Questions or Comments Below:
Acceptance of Terms and Conditions
I have read and accept the Terms and Conditions of this online contract and realize the chocolate fountain can not be used outdoors. Please click here to view Terms and Conditions of this Rental Contract Once your reservation has been confirmed, you will receive an e-mail contract form and invoice showing your total. A $150.00 deposit is required to hold the date. Payments are accepted via Paypal, Visa, Mastercard, or Check.


For questions please call or e-mail Pure Bliss Chocolate at (949) 228-3811 or info@pureblisschocolate.com.