Psychedelic Shop's Order Form
Your Name:
Email Address:
Your Mailing Address:
Phone Number:
Postage:
Normal
Registered
Meet up
Item 1:
Item name: Color: Price: Shipping: Qty:
Item 2:
Item name: Color: Price: Shipping: Qty:
Item 3:
Item name: Color: Price: Shipping: Qty:
Item 4:
Item name: Color: Price: Shipping: Qty:
Item 5:
Item name: Color: Price: Shipping: Qty:
Item 6:
Item name: Color: Price: Shipping: Qty:
Item 7:
Item name: Color: Price: Shipping: Qty:
Item 8:
Item name: Color: Price: Shipping: Qty:
* Note: For more than 8 items please email your orders personally in the same
format of Item, Color, Price, Shipping Qty, to
psychedelic@ymail.com!
:)
Total Amount Shipping:
Total No. of Items:
Other Comments:
FULL PAYMENT / DEPOSIT / TOP UP / OTHER ENQUIRIES * * delete if not applicable.
Mode of Transaction
ATM
Internet banking
Cash on Delivery
For others, please specify:
Transaction Details.:
Transaction Details : From Account POSB Savings XXX-XXXXX-X YourName To Account POSB Savings 030-51609-5 Jeanie Amount S$XX.XX Transaction Reference XXXXXXXXX