PESANAN / ORDER

Nama :
Email :
No H/P :
Alamat :
Nama Penerima :
Alamat Penghantaran (jika sama seperti diatas, abaikan):
Tarikh Terima :
Coklat Praline :	Loose 2 biji Praline (Plastik + Reben) 2 biji Praline (Sushi Box + Reben) 2 biji Praline (Golden Base + Reben) 2 biji Praline (Paper Box + Reben) 3 biji Praline (Paper Box + Reben) 4 biji Praline (Paper Box + Reben) 6 biji Praline (Paper Box + Reben) 9 biji Praline (Paper Box + Reben) 12 biji Praline (Paper Box + Reben) 25 biji Praline (Paper Box + Reben)
Praline Filling	Plain Almond Nibs Whole Almond
Oreo Chocolate	Edible Image
Lillichoc	Edible Image Mickey Mouse & Friends Smiley Love (Text) xoxo (Text)
Edible Image	Barbie Mickey & Minnie Mouse Hello Kitty
Chocolate Bar	Chocolate Bar - Small (3.5cm x 7cm) Chocolate Bar - Medium (3.5cm x 11.7cm) Chocolate Bar - Large(5.5cm x 12cm)
Kuantiti
Tema (jika ada)
Cara Pembayaran	Maybank Berhad CIMB Bank Berhad
Cara Penghantaran	Self Pickup By Hand POS Malaysia
Lokasi Self Pickup	LRT Masjid Jamek, KL Bandar Tasik Puteri, Rawang

Form provided by Freedback.