Order Form


Hope is to write down a mail order in the following form, and transmit a message. Tell how to pay it by E-Mail after 1-day-2 days. If you have any questions about the following letter, please feel free to contact me on chemin@mx7.ttcn.ne.jp.









E-Mail:
Name:
Address:
City:
State:
Zip:
Phone or Fax:
Products to Order: DECADENCE / Qty :
US$35.00 + International Charge

Warning To Mankind / Qty :
US$24.00 + International Charge

Value Set
( DECADENCE & Warning To Mankind ) / Qty :
Nice Price ! ASK!!
Message
( Question & Comment ):
Sex : Male Female


----- NEU TRINO label -----

chemin@mx7.ttcn.ne.jp
chemin@mx7.ttcn.ne.jp

426,HighCity Omotesandou,4-14-13
Jingumae,Shibuya-ku
Tokyo 150-0001
JAPAN

CHEMIN Inc / NEU TRINO

PHONE +81-3-5411-8175 / FAX +81-3-5411-8176


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