{% 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 a
current 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 Chocolates
for many years, developed the delicious marshmallow recipe. Its delicate, soft, and
magnificent center is coated with delicious Al-Meda's Chocolate. One word describes this
morsel, 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 dark
chocolate, 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 per
shipping 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 or
more 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 per
shipping 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 or
more 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 is
being sent to Canada or out of the country, additional postage is required.
</p>
</td>
</tr>
</table>
</div>
</form>
</div>
{% endblock %}