Jolly Jelly Mooncake - Order Form

Year 2014
Jolly Jelly Mooncake - Order Form
Full Name*
Mobile Number*

Area CodePhone Number
Email Address
Flavours & Quantity
RM25 per box . 4pcs per box

Please keep the jelly mooncakes in refrigerator. Best served in 3 days.

Pick the flavours for each box:

	Box 1	Box 2	Box 3	Box 4	Box 5	Box 6	Box 7	Box 8
Passion Fruit
Mango
Dragon Fruit
Red Bean
Sweet Corn
Red Dates
Yam

	Box 9	Box 10	Box 11	Box 12	Box 13	Box 14	Box 15	Box 16
Passion Fruit
Mango
Dragon Fruit
Red Bean
Sweet Corn
Red Dates
Yam

Order Collection

Please allow 3 working days to process your order. Only self-collection is available.
Collection Date*

DayMonthYear
BURGER KING, Bandar Bukit Tinggi 2 - 8.00pmTESCO, Puchong - 1 Sept, 11.30am (Special Delivery)
Special Request
Should be Empty: