BECOME A SUBSCRIBER

Become a subscriber of The Belgain Choclatique and not only receive a 5% discount on ALL purchases, but you will also receive a surprise assortment of our famous chocolates delivered to your door each month! (Walvis Bay and Swakopmund residents ONLY) Please ensure you fully understand our terms and conditions.

Name and Surname*

Contact Number*

Email Address*

Identification Number*

Gender
 Male Female

Date of Birth* (day/month/year)

Special Dates (see example)

Delivery Address*

When would you like to receive your standing order each month?
 First Week Middle of Month End of Month

Payment Method
 EFT Cash

Pay Preference
 Monthly Yearly

NOW FOR THE SWEET PART

Chocolate Preference
 Dark Milk White

Filled Favourites
 All Ben Hur Brandy log Caramel Heart Chocolate Mousse Cinnamon Cup Crème Brule Dark Dipped Cherries Frangelico Truffle Plain Frangelico Coconut Irish Coffee Cup Marzipan (Dark) Mocha Bean & Cappuccino Cup Nutty Caramel Nutty Crème Brule Orange Cream Peanut Butter Delight Peppermint Liquor Rooibos Rum Barrel Strawberry Cream Vanilla Cream

If you choose one of the following, please specify
Amarula Assortment

Praline Assortment

Terms and Conditions
 I accept