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Contact Information

Full Name:

Street Address:

City:

State:

Zip:

Home Phone:

Cell Phone:

E-mail:

Event Information

Event Type:

Event Location (Facility Name and Address):

Event Date:

Approx. Number of Guests:

Event Time (time you would like the fountain running): From:To:

Choice of Chocolate:

Semi-Dark
White
Milk


Size of fountain most interested in:

Large
Medium
Small


How did you hear about SilkWave Chocolate Fountains?:

Internet Search
Wedding Show
Premier Bride Ad
Friend, Co-worker, etc.
Other

Comments/Questions:

I would also like SilkWave to provide the dipping items for my event.
(Please indicate which items in the Comments box above)
I would also like a price quote for my event e-mailed to me.
I would like a brochure sent to my address.

Please make sure all information is correct before submitting.



THANK YOU FOR YOUR REQUEST!