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MAXLIFE PRODUCT ORDER FORM
Please fill-up the necessary informations then submit.
First Name:
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Middle Initial:
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Surname:
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Complete Shipping Address: Street / Brgy. / Town or City / Province / Country
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Email
Phone Number/s (Landline & Mobile)
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SELECT YOUR ORDER and QUANTITY
BARLEY JUICE PhP 180.00
QUANTITY
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1 Bottle
2 Bottle
3 Bottle
4 Bottle
5 Bottle
6 Bottle
7 Bottle
8 Bottle
9 Bottle
10 Bottle
Other Quantity (indicate in the Message Box)
BARLEY 60 CAPSULES @ PhP 550.00/BOTTLE
QUANTITY
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1 Bottle
2 Bottle
3 Bottle
4 Bottle
5 Bottle
6 Bottle
7 Bottle
8 Bottle
9 Bottle
10 Bottle
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GRAPESEED 1000mg x 30pcs @ PhP 500.00/BOTTLE
QUANTITY
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1 Bottle
2 Bottle
3 Bottle
4 Bottle
5 Bottle
6 Bottle
7 Bottle
8 Bottle
9 Bottle
10 Bottle
Other Quantity (indicate in the Message Box)
MAX COFFEE 21gms x 10 Sachet/box@Php 180.00
QUANTITY
Select Quantity
1 Box
2 Boxes
3 Boxes
4 Boxes
5 Boxes
6 Boxes
7 Boxes
8 Boxes
9 Boxes
10 Pcs.
Other Quantity (indicate in the Message Box)
You will received your products within 2 days after the clearing of your payments.
Shipping cost will be added. 75.00 Metro Manila, 130 Luzon, 150 VizMin
Message:
Assistance Hotline: (+63) 2183630; +639155291555; +63932-7190-555
YM: winalight@yahoo.com SKYPE: rhpascua
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