{% extends 'base.html.twig' %}{% set title = 'Order' %}{% block javascripts %}<script src="https://code.jquery.com/jquery-3.4.1.min.js"integrity="sha256-CSXorXvZcTkaix6Yvo6HppcZGetbYMGWSFlBw8HfCJo="crossorigin="anonymous"></script><script src="https://code.jquery.com/ui/1.12.1/jquery-ui.min.js"integrity="sha256-VazP97ZCwtekAsvgPBSUwPFKdrwD3unUfSGVYrahUqU="crossorigin="anonymous"></script><script src="https://stackpath.bootstrapcdn.com/bootstrap/4.3.1/js/bootstrap.bundle.min.js"integrity="sha384-xrRywqdh3PHs8keKZN+8zzc5TX0GRTLCcmivcbNJWm2rs5C8PRhcEn3czEjhAO9o"crossorigin="anonymous"></script><script src="https://cdnjs.cloudflare.com/ajax/libs/bootbox.js/5.3.2/bootbox.min.js"integrity="sha256-s87nschhfp/x1/4+QUtIa99el2ot5IMQLrumROuHZbc=" crossorigin="anonymous"></script><script>{{ js|raw }}</script>{{ encore_entry_script_tags('order') }}{% endblock %}{% block body %}<div id="content"><form name='order_form' id='order_form' onsubmit="popVals()" action="{{ path('app_default_ordersubmit') }}"method="post"><table id="main_table"><tr><td><p id="main_heading">Al-Meda Chocolates Order Form!!!!</p><p id="instructions">If you would prefer the mail or fax options, fill<br/> in your order,then <a href="#" onclick="window.print()">click here</a> to print it.<br/><br/><span style="font-weight: bold;">Please note that if you print and fax this, do NOT submit it electronically!</span><br/>This will result in a duplicated order!</p></td></tr><tr><td><p id="address">PO Box 444 23050 County Road E Archbold, OH 43502<br/>Phone (419) 446-2676 Toll free (800) 343-0333 Fax (419) 446-4810</p></td></tr><tr><td><table class="inner_table"><tr><td class="subheading">Billing Information</td></tr><tr><td><table class="level3table"><tr><td colspan="2"style="text-align: left; padding-left: 15%; font-weight: bold; font-size: 9pt;">* - Required fields</td></tr><tr><td class="leftcol"><label for="bill_name">* Name:</label></td><td class="rightcol"><input class="mwd-required" id="bill_name"name="bill_name" type="text" size="63"/></td></tr><tr><td class="leftcol"><label for="bill_street">* Street:</label></td><td class="rightcol"><input class="mwd-required" name="bill_street"id="bill_street" type="text" size="63"/></td></tr><tr><td class="leftcol"><label for="bill_street_2"> </label></td><td class="rightcol"><input name="bill_street_2" id="bill_street_2" type="text" size="63"/></td></tr><tr><td class="leftcol"><label for="bill_city">* City:</label></td><td class="csz rightcol"><input class="mwd-required" name="bill_city"id="bill_city" type="text" size="28"/><label>* State: <input class="mwd-required" name="bill_state"id="bill_state" type="text"size="2"/></label><label>* Zip: <input class="mwd-required" name="bill_zip" id="bill_zip"type="text" size="10"/></label></td></tr><tr><td class="leftcol">* Phone:</td><td class="phone rightcol"><label><input class="mwd-required"style="margin-left: 0;" name="day_phone" id="day_phone"type="text"/>(daytime)</label></td></tr><tr><td class="leftcol">* Phone:</td><td class="phone rightcol"><label><input class="mwd-required"style="margin-left: 0;" name="eve_phone" id="eve_phone"type="text"/>(evening)</label></td></tr><tr><td class="leftcol"><label for="email">* Email:</label></td><td class="rightcol"><input class="mwd-required" name="email" id="email"type="email" size="63"/></td></tr></table></td></tr></table></td></tr><tr><td> </td></tr><tr><td><table class="inner_table"><tr><td class="subheading" colspan="2">Payment Information</td></tr><tr><td id="cc_warning" colspan="2">For security reasons, we will contact you for credit card information. If you have acurrent credit card on file with us, that will be used.</td></tr><tr><td class="instructions" colspan="2">Appropriate shipping charges {#and discounts #}will be added when we process this order.</td></tr><tr><td class="instructions" colspan="2"><label><input name="check_mo_encl" type="checkbox"/>Check / Money Order Enclosed</label></td></tr><tr><td class="instructions" colspan="2">Please Charge my:</td></tr><tr><td class="instructions" colspan="2"><table class="cc"><tbody><tr><td>[ ] Visa</td><td>[ ] MasterCard</td><td>[ ] American Express</td></tr></tbody></table></td></tr><tr><td class="instructions"> Card No: ________________________________________</td><td class="instructions"> Security Code: _________ <a href="#"onclick="window.open('https://en.wikipedia.org/wiki/Card_Security_Code');return false;">What is this?</a></td></tr><tr><td class="instructions">Signature: ________________________________________</td><td class="instructions">Exp Date: _______ / ________</td></tr></table></td></tr><tr><td><input type="hidden" id="recip_nums" name="recip_nums"/></td></tr><tr><td id="ship_to_head0"></td></tr><tr><td><input type="button" value="Additional Recipient" id="add_ship_to0" name="add_ship_to0"/></td></tr><tr><td><table class="notes_table"><tr><td class="leftcol"><label for="total_price">Total Price:</label></td><td class="rightcol"><input size="8" type="text"id="total_price"name="total_price"value="0.00"style="text-align: right;"disabled="disabled"/></td></tr><tr><td class="leftcol" style="vertical-align: top;"><label for="notes">Notes:</label></td><td class="rightcol"><textarea name="notes" id="notes"></textarea></td></tr><tr><td colspan="2" style="text-align: center;"><input type="submit"value="Submit Order"id="submit_order"name="submit_order"onmouseover="popVals()"disabled="disabled"/></td></tr></table></td></tr></table><div style="margin-top: 12px;"><table class="inner_table price_list"><tr><td style="background-color: #000000; color: #FFFFFF; font-size: 12pt; font-weight: bold;"colspan="8">Price List</td></tr><tr class="subheading"><td colspan="4">Al-Meda Famous Chocolate Stix</td><td colspan="4">Al-Meda Marshmallow Treats</td></tr><tr style="text-align: justify;"><td colspan="4" style="vertical-align: top;">Our most popular and favorite item! <span style="font-style: italic;">Milk, Dark or Mixed Chocolate</span></td><td colspan="4">This old favorite is available right now. John Rupp, who was the owner of Al-Meda Chocolatesfor many years, developed the delicious marshmallow recipe. Its delicate, soft, andmagnificent center is coated with delicious Al-Meda's Chocolate. One word describes thismorsel, fantastic! Order early, we make just a few batches.</td></tr><tr>{#<td colspan="8"><h3 style="text-align: center;">At the present time, we are SOLD OUT of Chocolate Stix and Assorted Chocolates.</h3></td>#}<td style="text-align: right;">1/4-lb. box</td><td class="price_right">{{ chocArray[0].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">1-lb. box</td><td class="price_right">{{ chocArray[2].ProductCost|format_currency('USD') }}</td><td colspan="2" style="text-align: right;">3/4-lb. box</td><td class="price_right" colspan="2">{{ chocArray[13].ProductCost|format_currency('USD') }}</td></tr><tr><td style="text-align: right;">1/2-lb. box</td><td class="price_right">{{ chocArray[1].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">2-lb. box</td><td class="price_right">{{ chocArray[3].ProductCost|format_currency('USD') }}</td><td colspan="2" style="text-align: right;">1.5-lb. box</td><td class="price_right" colspan="2">{{ chocArray[14].ProductCost|format_currency('USD') }}</td></tr><tr><td colspan="3" style="text-align: right;">3-lb. box</td><td class="price_right">{{ chocArray[4].ProductCost|format_currency('USD') }}</td><td colspan="2" style="text-align: right;">{#2-lb. box#}</td><td class="price_right" colspan="2">{#{{ chocArray[7].ProductCost|format_currency('USD') }}#}</td></tr><tr class="subheading"><td colspan="4">Al-Meda Mints</td><td colspan="4">Al-Meda Chocolate Covered Nuts</td></tr><tr><td colspan="4" style="text-align: justify;">Creamy mint centers dipped in a rich chocolate shell. <span style="font-style: italic;">Milk, Dark or Mixed Chocolate</span></td><td colspan="4" style="text-align: justify;">A real favorite with many people. Your choice of nuts or we'll pack to your liking. <span style="font-style: italic;">Milk, Dark or Mixed Chocolate</span></td></tr><tr>{#<td colspan="4" rowspan="2"><h3 style="text-align: center;">At the present time, we are SOLD OUT of Mints.</h3></td>#}<td style="text-align: right;">1/4-lb. box</td><td class="price_right">{{ chocArray[8].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">1-lb. box</td><td class="price_right">{{ chocArray[10].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">1/2-lb. box</td><td class="price_right">{{ chocArray[17].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">2-lb. box</td><td class="price_right">{{ chocArray[19].ProductCost|format_currency('USD') }}</td></tr><tr><td style="text-align: right;">1/2-lb. box</td><td class="price_right">{{ chocArray[9].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">2-lb. box</td><td class="price_right">{{ chocArray[11].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">1-lb. box</td><td class="price_right">{{ chocArray[18].ProductCost|format_currency('USD') }}</td><td style="text-align: right;">3-lb. box</td><td class="price_right">{{ chocArray[20].ProductCost|format_currency('USD') }}</td></tr><tr class="subheading"><td colspan="4">Al-Meda Gourmet Chocolate Covered Pretzels</td><td colspan="4">Bits 'N Pieces</td></tr><tr><td colspan="4" style="text-align: justify;">Small sized, twisted pretzels dipped in Al-Meda's high-quality delicious milk or darkchocolate, and packaged in one pound bags. Your choice of milk or dark chocolate.</td><td colspan="4" style="text-align: justify;">These are the broken centers of the Stix, dipped in Al-Meda chocolate, same great taste as the Stix!Sorry, they aren't available mixed, <span style="font-style: italic;">only milk or dark chocolate. </span>Packed in one-pound bags.</td></tr><tr><td colspan="2" style="text-align: right;">1-lb. bag</td><td colspan="2" style="text-align: left;">{{ chocArray[15].ProductCost|format_currency('USD') }}</td>{#<td colspan="4"><h3 style="text-align: center;">At the present time, we are SOLD OUT of Bits 'N Pieces.</h3></td>#}<td colspan="2" style="text-align: right;">1 lb bag</td><td colspan="2" style="text-align: left;">{{ chocArray[12].ProductCost|format_currency('USD') }} per bag</td></tr>{#<tr><td colspan="4" style="text-align: justify;">Shipping for Pretzels are $11.00 for 1 bag per shipping address; $13.00 for 2 bags pershipping address. There is a $2.50 surcharge for the following states: AK., AZ., CA., CO., HI., ID.,OR., NV., MT., NM., UT., WA., WY. and US Virgin Islands. Regular shipping charges apply to 3 ormore bags per shipping address, please refer to the shipping table for prices.</td><td colspan="4" style="text-align: justify;">Shipping for Bits 'N Pieces are $11.00 for 1 bag per shipping address; $13.00 for 2 bags pershipping address. There is a $2.50 surcharge for the following states: AK., AZ., CA., CO., HI., ID.,OR., NV., MT., NM., UT., WA., WY. and US Virgin Islands. Regular shipping charges apply to 3 ormore bags per shipping address, please refer to the shipping table for prices.</td></tr>#}<tr class="subheading"><td colspan="8">Fresh Nuts!!</td></tr><tr><td colspan="8" style="text-align: left;">For anyone who wants to enjoy great tasting nuts naturally, they are available year round. Packaged in plastic bags, and tied with colorful ribbon.</td></tr><tr class="nut_heading"><td colspan="4">Roasted Salted Cashews</td><td colspan="4">Mammoth Pecan Halves</td></tr><tr><td colspan="2" style="text-align: right;">8 oz.</td><td class="price_right" colspan="2">{{ nutsArray[4].ProductCost|format_currency('USD') }}</td><td colspan="2" style="text-align: right;">8 oz.</td><td class="price_right" colspan="2">{{ nutsArray[7].ProductCost|format_currency('USD') }}</td></tr><tr><td colspan="2" style="text-align: right;">16 oz.</td><td class="price_right" colspan="2">{{ nutsArray[5].ProductCost|format_currency('USD') }}</td><td colspan="2" style="text-align: right;">16 oz.</td><td class="price_right" colspan="2">{{ nutsArray[8].ProductCost|format_currency('USD') }}</td></tr><tr><td colspan="2" style="text-align: right;">32 oz.</td><td class="price_right" colspan="2">{{ nutsArray[6].ProductCost|format_currency('USD') }}</td><td colspan="2" style="text-align: right;">32 oz.</td><td class="price_right" colspan="2">{{ nutsArray[9].ProductCost|format_currency('USD') }}</td></tr><tr class="nut_heading"><td colspan="4">Roasted Salted Almonds</td><td colspan="4">Fresh Mixed Nuts</td></tr><tr><td colspan="2" style="text-align: right;">8 oz.</td><td class="price_right" colspan="2" style="width: 25%; text-align: left;">{{ nutsArray[10].ProductCost|format_currency('USD') }}</td><td colspan="2" style="width: 25%; text-align: right;">8 oz.</td><td class="price_right" colspan="2" style="width: 25%; text-align: left;">{{ nutsArray[13].ProductCost|format_currency('USD') }}</td></tr><tr><td colspan="2" style="width: 25%; text-align: right;">16 oz.</td><td class="price_right" colspan="2" style="width: 25%; text-align: left;">{{ nutsArray[11].ProductCost|format_currency('USD') }}</td><td colspan="2" style="width: 25%; text-align: right;">16 oz.</td><td class="price_right" colspan="2" style="width: 25%; text-align: left;">{{ nutsArray[14].ProductCost|format_currency('USD') }}</td></tr><tr><td colspan="2" style="width: 25%; text-align: right;">32 oz.</td><td class="price_right" colspan="2" style="width: 25%; text-align: left;">{{ nutsArray[12].ProductCost|format_currency('USD') }}</td><td colspan="2" style="width: 25%; text-align: right;">32 oz.</td><td class="price_right" colspan="2" style="width: 25%; text-align: left;">{{ nutsArray[15].ProductCost|format_currency('USD') }}</td></tr></table></div>{#<div style="margin-top: 12px;"><table class="inner_table"><tr><td colspan="4"class="discount_sh_heading">Discounts on Boxed Chocolates</td></tr><tr><td style="width: 25%; text-align: right;">200 lbs or more</td><td style="width: 25%;">$1.50 discount per pound</td><td style="width: 25%; text-align: right;">50 lbs or more</td><td style="width: 25%;">$.75 discount per pound</td></tr><tr><td style="width: 25%; text-align: right;">150 lbs or more</td><td style="width: 25%;">$1.25 discount per pound</td><td style="width: 25%; text-align: right;">25 lbs or more</td><td style="width: 25%;">$.50 discount per pound</td></tr><tr><td style="width: 25%; text-align: right;">100 lbs or more</td><td style="width: 25%;">$1.00 discount per pound</td><td> </td><td> </td></tr></table></div>#}<div style="margin-top: 12px;"><table class="inner_table"><tr><td colspan="4" class="discount_sh_heading">Shipping & Handling, per Address</td></tr><tr class="subheading"><td style="width: 25%;">Merchandise Total</td><td style="width: 25%;">Shipping Fee</td><td style="width: 25%;">Merchandise Total</td><td style="width: 25%;">Shipping Fee</td></tr><tr><td style="width: 25%; text-align: right;">$8.01 - $24.50</td><td style="width: 25%; text-align: left; padding-left: 9%;">$10.00</td><td style="width: 25%; text-align: right; font-size: small;">$200.01 - $400.00</td><td style="width: 25%; text-align: left; padding-left: 9%">$25.00</td></tr><tr><td style="width: 25%; text-align: right;">$24.51 - $45.50</td><td style="width: 25%; text-align: left; padding-left: 9%">$14.00*</td><td style="width: 25%; text-align: right;">$400.01 - $1500.00</td><td style="width: 25%; text-align: left; padding-left: 9%">$35.00</td></tr><tr><td style="width: 25%; text-align: right;">$45.51 - $200.00</td><td style="width: 25%; text-align: left; padding-left: 9%">$15.00*</td><td colspan=2>Over $1,501.00 shipping cost based upon UPS quoted charge</td></tr>{#<tr><td style="width: 25%; text-align: right;">#}{#Up to $8.00#}{#</td><td style="width: 25%; text-align: left; padding-left: 10%;">#}{#$4.00#}{#</td><td style="width: 25%; text-align: right;">Over $1,500.00</td><td style="width: 25%; text-align: left; padding-left: 9%">$46.00</td></tr>#}<tr><td colspan="4"><p style="text-align: left; font-family: Arial, sans-serif; font-size: 10pt;">*$2.50 surcharge for package value of $24.51 to $200.00 sent to AK., AZ., CA., CO., HI.,ID., MT., OR., NV., NM., UT., WA., WY. and US Virgin Islands.</p><p style="text-align: left; font-size: 11pt; font-family: Tahoma, serif;">The shipping charge includes shipping, handling and insurance. If your package isbeing sent to Canada or out of the country, additional postage is required.</p></td></tr></table></div></form></div>{% endblock %}