Philippine Based Client Application Form

* fields in bold are required.
Name        
     
         
Email Address        
     
         
Contact No. Area code   Phone Number      
Home    
Mobile    
Work    
       
Date of Birth (must be 21yrs old & above)      
     
         
Billing Address        
 
         
Delivery Address        
 
NOTE: Billing address should be the same as the billing address of your credit card.
         
Average Shipment per month:      
           
   
  PLEASE ATTACH NOT MORE THAN 500KB.
Supported files (.zip, .doc, .pdf, .txt, .rar, .docx, .gif, .jpg, .JPG, .jpeg, .png)
         
Remarks        
 
 
Press Down to see the rest of the liability limitation and terms of agreement.
If you accept the Liability Limitation, click the checkbox
 


  
Please allow 24 hours to receive your reply via email.

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