Please print out and use it.
CROSSWING ORDER FORM
FAX 81-864-35-9150
ITEM NUMBER DESCRIPTION QUANTITY PRICE EACH TOTAL PRICE
SUBTOTAL
SHIPPING
TOTAL DVE

ZIP CUSTOMER NO
ADDRESS
NAME AGE
TEL FAX
E-MAIL



PAYMENT VISA    ・    MASTER    ・    JCB   ・    AMEX
CARD NO     -       -       -      GOOD THRU    M        YEAR
1-4-23 HAMANOCHAYA KURASHIKI-CITY OKAYAMA JAPAN
TEL 81-864-25-4511 FAX 81-864-35-9150
Please fax 81-864-35-9150 after printing out this page and filling in a necessary matter at the fax order.