BURN PRODUCTS ORDER FORM (PAYPAL PAYMENT)

CUSTOMER's INFORMATION

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Customer's Name*

First NameLast Name
E-mail*
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SHIPPING DETAILS:

Please indicate the COMPLETE DETAILS of the Receiver.
Ship To:*

First NameLast Name
Contact Number*
Shipping Address*

Street Address

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CityState / Province

Postal CodeCountry
BURN SLIM TABLET 30 tablets ( 1,200 Php )*

1 box2 boxes3 boxes4 boxes5 boxes6 boxes7 boxes8 boxes9 boxes10 boxesNO Thanks
BURN MEAL SHAKE 15 Sachets (1,300 Php)*

1 box2345678910NO Thanks
BURN ICED TEA 20 Sachets ( 1,100 Php )*

1 box2345678910NO Thanks
BURN LIVEN COFFEE 20 Sachets*

1 box2345678910NO Thanks
SHIPPING RATE:

Please CHOOSE the CORRECT shipping rate based on your SHIPPING ADDRESS to prevent your order to put on Hold.
LBC (METRO MANILA) - Makati, Pasig, Las Pinas, Caloocan, Manila, Mandaluyong, San Juan, Quezon City*

1 - 2 boxes Php 190.003 - 5 boxes Php 300.006 - 7 boxes Php 450.008 - 10 boxes Php 500.00NOT Metro Manila
LBC (PROVINCIAL)- Antipolo City, Rizal, Cavite, Batangas, Luzon, Visayas, Mindanao*

1 - 2 boxes Php 280.003 - 5 boxes Php 350.006 - 7 boxes Php 500.008 - 10 boxes Php 700.00NOT Provincial
SHIPPING INTERNATIONAL:*

1 to 10 Items = 1,500 Php11 to 15 Items = 2,000 Php16 to 20 Items = 2,500 PhpNOT International
TOTAL:
DO NOT FORGET YOUR TOTAL AMOUNT.
YOUR FREE ITEM:

BURN Slim 1 boxRestorlyf 1 boxHerbal Toothpaste 1 boxLiven Coffee 1 boxOther
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