Contact Information & Order Form (Please fill out your contact information below.)
by: J.Brucelo Online Shop
Complete Name
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FIRST NAME
M.I.
LAST NAME
Facebook Account/name
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Instagram Account/name
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Complete Shipping Address
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PLEASE INDICATE YOUR COMPLETE SHIPPING ADDRESS AND DOUBLE CHECK IT
Order/s
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NAME, QUANTITY AND PRICE OF THE PRODUCT
e-mail Address
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telephone number
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cellphone number
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Mode of Payment (M.O.P.)
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Western Union Money Transfer
Cebuana Lhuillier Pera Padala
MLhuillier (ML Kwarta Padala)
Smart Padala
BPI SAVINGS (PREFERRED)
Payment Details for CEBUANA LHUILLIER; MLHUILLIER; WESTERN UNION. Name: LADY MICHELLE SILVERIO - DULCE; Address: NORTH SUSANA EXECUTIVE VILLAGE, QUEZON CITY 1119
Exact Date & Time of Payment:
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Day
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AM/PM Option
PLEASE READ THE TERMS AND CONDITIONS (VERY IMPORTANT)...
Again! You need to be 101 % sure in purchasing the item/s stated above. Pay on the deadline. Or we will put your photo in our BOGUS ALBUM. THANK YOU.
Courier
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Air21
LBC
JRS Express
EMS for (International)
Meet Ups (50 pesos handling fee)
notes
suggestions/comments
I AGREE WITH THE TERMS AND CONDITIONS OF J.Brucelo Online Shop and that I will pay total amount due on my chosen Date & Time of Payment. (Only 2 days Reservation allowed.)
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