Order Form

Online FilStore.Com ( Subsidiary of PesoEpadala.Com Ltd)

                                               Invoice No. ___________ (Office use only)

Sender

Name * :

Address * :

City *:                                                               Zip code:

State (Province)*:                                               Country*:

E-mail :                                                           Fax:

Home Phone*:                                                   Work Phone:



Recipient

Name * :

Address1 *:

City * :                                                              Zip Code:

Province*:                                                         Home Phone * :

Cell Phone:                                                       Work Phone * :

Landmarks/Directions/Special Delivery Instructions:

Message:

Purchases

Product

Product

Color

Quantity

Unit Price

Total

Code

Description

(a)

(b)

(a) x (b)

Sub-total

Delivery (for addresses outside MM)

GRAND TOTAL

* Required fields

How did you hear about us?    Flyer Search engine    Heard from a friend    Received a mailer     Other

For faxed check payments, please place check in this area and tape at the corners.

For credit card payments, please fill in the following:

Card type:          ___Visa       ___Master        ____American Express

Card Number:    _______    ________    _________    ________     Exp. date (mm/yyyy)    __________

Signature: __________________________________________     Date: ___________

Fax to (675) 320-28-89 or mail to OnlineFilStore P.O. Box 8238 Boroko NCD Papua New Guinea

MARAMING SALAMAT PO!!

Rev. 07/2002