Pick Up in Rockford, MI Order Form

Thank you for supporting Clara Cookies. We will contact you soon to make arrangements for pick up.
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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My Order

Item {binding ItemNumber}

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Combo Packs  2 Peanut Butter Chocolate Chip, 2 Coconut Dark Chocolate Chip, 2 Mint Chocolate Chip, 2 Orange Cranberry, 2 Dark Chocolate Chip, 1 Lemon Poppy Seed, 1 Snickerdoodle

. To order more than one flavor, choose "Add Item".

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{~ Payment_Block_Label}

{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{binding Name}:{binding displayValue}---
{{ Cognito.resources['payment-amount-due'] + ":" }} {binding displayValue}

Pick Up in Rockford, MI Order Form

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{{ Cognito.resources['order-billing-info-header'] }}

{binding BillingName}
{binding PhoneNumber}
{binding EmailAddress}
{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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My Order

Item {binding ItemNumber}

Product {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Item Total {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
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Discount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
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Pick Up in Rockford, MI Order Form

Thank you for supporting Clara Cookies. We will contact you soon to make arrangements for pick up.

{{ Cognito.resources['order-transaction-details-header'] }}

{{ Cognito.resources['order-number-label'] }}: {binding displayValue}
{{ Cognito.resources['order-date-label'] }}: {binding displayValue}
{{ Cognito.resources['order-method-label'] }}: {binding MethodReference}

{{ Cognito.resources['order-billing-info-header'] }}

{binding BillingName}
{binding PhoneNumber}
{binding EmailAddress}
{binding Group}
{binding Name} - {binding Description}{binding displayValue}
{{ Cognito.resources['payment-subtotal'] + ":" }}{binding displayValue}
{{ Cognito.resources['order-total-label'] }}: {binding displayValue}
{{ Cognito.resources['order-amount-paid'] }}:({binding displayValue})
{{ Cognito.resources['order-balance-due-label'] }}:{binding displayValue}
Name {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Billing Address {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Email {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Phone {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }

My Order

Item {binding ItemNumber}

Product {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Quantity {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Item Total {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
{ binding firstError.message }
Discount Code {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{binding displayValue}
{ binding firstError.message }
Discount {{ Cognito.resources["required-asterisk"] }} , { binding firstError.message }
{ binding firstError.message }
Cognito Forms{{ Cognito.resources["powered-by-cognito"] }}