Alternative Order Form with Additional Options Checklist

ORDER FORM

by: Beli-Beli Baju
Complete Name*

FIRST NAMEM.I.LAST NAME
Facebook Account/name*
Complete Shipping Address*
PLEASE INDICATE YOUR COMPLETE SHIPPING ADDRESS AND DOUBLE CHECK IT
Order/s*
NAME, QUANTITY AND PRICE OF THE PRODUCT
e-mail Address*
telephone number*
cellphone number*
Klik BcaInternet BankingCOD
Exact Date of Payment*
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. THANK YOU.
JNETIKIPosCOD
notes
suggestions/comments
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ORDER FORM