To place an order, please fill out this form. If you want to order 25 or more pins, please use the wholesale form.

When you are finished, print this form and send it, with your check or money order, to:

Columbus House Rabbit Society
P.O. Box 29444
Columbus, OH 43229

Checks and money orders should be made out to Columbus House Rabbit Society.

If you have any difficulties with this form, please send an e-mail with your order information to Make Mine Chocolate Orders. Your shipping costs and total amount will be sent to you.

Thank you for your support!

Your Name

Your E-mail

Your Address

Your Phone Number

Product			Price	Quantity	Total
The Make Mine Chocolate Pin			$5
Shipping
Your Total Payment (including tax)				$

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