Order Form	
    Please fill in all of the boxes below.
If you wish to pay via money order or personal check,
fill out all information except the credit card box.
Especially important is your e-mail address or telephone number 
(in case of questions we might have)
 Contact information:
regular mail * (slow mail) 
Reflections of Asia - jun antolin -david rogers 
6301 Misty Wood Way
Citrus Heights, CA 95621 
Telephone = land line (916) 723 8528  Fax * (916) 723-4228   - I Phone (916) 806-8714
 e-mail *  jun@reflectionsofasia.com    jun6301us@yahoo.com  jackson6301@yahoo.com 
WALANG DELIVERY PO - MULA  JULY 14 TO AUGUST 15,  2014.

ease provide the following contact information:

Name  
Street address  
Address (cont.)
City  
State/Province  
Zip/Postal code  
Country
Contact Phone  
E-mail  

Please provide the following ordering information:

QTY DESCRIPTION
 

FOR CREDIT CARD ORDERS, PLEASE SEND YOUR CREDIT CARD INFO VIA one of the 4 following methods|
print this form and include Credit card information (cardholder name, credit card #, expiration date)  via fax, telephone, or mail
1) FAX to (916) 723-4228
2) TELEPHONE : email me na lang po
3) MAIL to } Reflections of Asia,  6301 Misty Wood Way, Citrus Heights, CA 95621 USA
4.CREDIT CARD INFORMATION
 cardholder's name
credit card number 
expiration date        

  SHIPPING
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

MARAMING SALAMAT PO,
jun antolin  ang tagapaglingkod sa inyo.

Copyright reflectionsofasia.com
Last revised: July 11, 2014