Order Form "Leisure 18 Slimming Coffee"
Name : *
Address *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *
Email *
CP Number: *
How many Box : *
Price *
State where Peso or Dollar

Philippines :
1 box = 250php "Free Shipping" (Metro Manila ONLY)
1 box = 280php "Free Shipping" (Provincial Rate)

International:
1 box = $10 "Free Shipping"
Date

MM		/
DD		/
YYYY
Mode of Payment *
 BDO 
 GCASH 
 Paypal 
 Cash on Meet ups 
Note @ Cash and meet ups!

if you order 3 boxes and above.
The item is located in Cainta Rizal.

Preferred Meet Up places:

Sta Lucia East Grand Mall
Robinsons Metro East
SM Marikina
SM TayTay
Gateway Mall
Mode of Shipping *
 Shipping via XEND EXPRESS 
 Meet ups 
 Others 
Note @ Meet Ups!

if you order 3 boxes and above.
The item is located in Cainta Rizal.

Preferred Meet Up places:

Sta Lucia East Grand Mall
Robinsons Metro East
SM Marikina
SM TayTay
Gateway Mall
OTHER CONCERNS (STATE HERE)

Call/Text @ 09085508136

Email add: mz.gr4ce@gmail.com *
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