ORDER FORM


You can send this order form by clicking the button
below or you may print out the form provided and fax us.


NAME

COMPANY NAME


※You may leave this blank if not applied by company.

DEPARTMENT

POST CODE

ADDRESS

Ｔ Ｅ Ｌ

Ｆ Ａ Ｘ

E-MAIL

※ Please be sure to enter your e-mail address.

Importer
( if other than consignee )



Please let us hear of your opinions etc.

Product Name

Product No.

Amount

Price

Yen

Yen

Yen

Yen

Yen

Yen


　

We may confirm the order within 1-2 working days upon receipt of this order form.
We will also inform you of the way of payment, bank details etc.
Products will be shipped upon receipt of charges paid in full to the bank account or you may choose cash on delivery post.


If you have a difficulty sending through this form, please send us all required details and send email to
shiro.s@viola.ocn.ne.jp
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