Dorothy Fragrance - Special Order Form

PERSONAL INFORMATION
Name:
Delivery Address :
Poscode :
Email Address:
Phone :
*BANK-IN INFORMATION*
Amount :
Date :
Time :
Location :
Example : Amount : RM72.00 Date : 28/11/08 Time : 02:40PM Location : SST JURU 2 / Online Transfer(if use online banking)
PLEASE SCAN AND SEND YOUR BANK SLIP TO DOROTHY.FRAGRANCE@YAHOO.COM AND PLEASE KEEP YOUR BANK SLIP, THANK YOU. FOR ONLINE transfer, PLEASE PRINT SCREEN YOUR STATEMENT AND SEND IT TO DOROTHY.FRAGRANCE@YAHOO.COM , THANK YOU.
*ORDER SECTION*
PLEASE CHOOSE YOUR PERFUME BRANDS & QUANTITY AT BELOW, THERE IS 10 CHOICE PER SUMBIT, NOT ENOUGHT PLEASE RESUBMIT, THANK YOU