MIRACLE TREAT DAY ORDER FORM

Business Name*

Contact Name*

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Pick Up Date & Time*

Please let us know if there are any allergies in your group.

Blizzards & Coupons *

Blizzard CouponsOur coupons are an easy, space-saving alternative to traditional Blizzard orders—great for staff who are away or as a thank-you treat for clients, all while support BCCHF. Valid at all participating DQ locations across Canada.

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Choco Brownie Extreme Blizzard

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Cookie Dough Blizzard

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Oreo Blizzard

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Skor Blizzard Gluten Friendly Option

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Smarties Blizzard

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Strawberry Cheesecake Blizzard

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Reese PB Cup BlizzardContains Peanuts

$7.39CAD

Size	Quantity	Price
Small		$7.39CAD
Medium		$8.19CAD
Large		$9.19CAD

Item subtotal:$0.00CAD

Additional DonationIf you would like to add an additional donation to your order please enter it here.

$1.00CAD

	Amount	Price
$		$1.00CAD
¢		$0.01CAD

Item subtotal:$0.00CAD

Subtotal

$0.00CAD

Tax

$0.00CAD

Total

$0.00CAD

Payment Type*

Payment can be made in person the day of the event, or by calling our store and paying with a credit card. Cheques can be made out to Lloyd Moulton Ltd. Thank you!

Additional Comments or Questions

Pre-Order Form