CHRISTMAS HAMPERS'99 Order Form

We will reply back as soon as possible

Just complete this form. Click on Submit when ready to send.

Your name:
Email :
Address:
Postal Code:
Company Name:
Company Add:
Contact No.:

Order

Order Quantity:

Send to where?

Office
Home
Hospital
Others

Specify/Address:

Message:

Delivery Appointment

Day:

Month:

Year:

Time:

Choose A Time Slot:

Note: Closing Date is on midnight 28^th November 1999.

Important Notes

We will contact you by phone to confirm your order.
The delivery is subjected to the time slots available for booking.
All payments must be made in cash or cash cheque upon confirmation.

All Rights Reserved (c) 1999 Clearimage Enterprise.