# Order form

- Date of order:

- Delivery date:                            Morning time (       )   , Afternoon time (       )

# Order

Product (Name of Item) :

Product price :

Please copy address of picture page (URL).

Delivery charge : USD$15 (      )   , USD$30 (       )  , USD$50 (        )

# Send to

Recipient Name:

Address:

Phone No.:

Message:

# From

Name:

Phone No. :       

Location of Country:

E-mail Address:

# Payment

Total price : Product + Delivery charge  =

Card holder:

Bank (Card company):

Credit Card No. :

Expiry Date: