Nostalgia Package Order Form

Mail to:

Luehm Candy Company

46 Buttermilk Hollow Road

North Huntingdon, PA 15642

Nostalgia Box Ordered by:

Name: ____________________________________________________

Street Address: _____________________________________________

City, State, Zip _____________________________________________

Payment: _____ Cash _____ Check ______ Visa ______ Mastercard ________Discover (we do not accept American Express)

Credit Card # _ _ _ _ - _ _ _ _ -_ _ _ _ - _ _ _ _ expiration date ___ / ___

Number of boxes _____ @ $27.95 + Shipping __________ Total Amount Due

Ship to:

Name _____________________________

Street Address ________________________________

City, State, Zip _______________________________

Message to Recipient: ________________________________________________________________