Order Form
Name
*
First
Last
Block / House No
Street
Unit No
Postal Code
Phone Number
Email
*
Confirm Email Email
*
DELIVERY SECTION
Please choose mode of delivery
Mode of Delivery
Normal Mail +$1.50
Registered Mail +4.00
Courier Service +6.00
Time Preferred
(Courier service)
2pm to 4pm
4pm to 6pm
6pm to 8pm
ORDERING SECTION
Item No 1
*
Colour ( if applicable )
Quantity
*
Price
*
Item No 2
Colour (if applicable)
Quantity
Price
Item No 3
Colour (if applicable)
Quantity
Price
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