Borang Tempahan

Borang Pesanan UmmieChocolate Sila isikan maklumat anda dengan betul untuk memudahkan proses tempahan.
Nama Anda*
Alamat Anda	Street Address Address Line 2 City State / Province / Region Postal / Zip Code Antigua and BarbudaAruba,BahamasBarbadosBelizeCanadaCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabwe Country
No Telefon*	Cth : 0123456789
Email Anda*	cth:pakcikkayo@gmail.com
Jenis Coklat	Milk Chocolate (50pcs/box) - RM 30   White Chocolate (50pcs/box) - RM 30   Milk Choc+Almond/Raisin/Peanut (50pcs/box) - RM 35   White Choc+Almond/Raisin/Peanut (50pcs/box) - RM 35   Milk Choc +Dates (30pcs/box) - RM 24   White Choc + Strawberry Filling (50pcs/box) - RM 35   Milk Choc + Strawberry Filling (50pcs/box) - RM35  *Harga tidak termasuk Kos Penghantaran dan kadar kos bergantung kepada lokasi.
Cara Bayaran	Cash On DeliveryATM/Online Transfer MaybankATM/Online Transfer CIMB
Bukti Pembayaran	Sila Copy & Paste Bukti Pembayaran sekiranya anda menggunakan Maybank2u/CIMB Clicks