ChiE/Eng

 

ORDER FORM

Tick the box □ for the item you want to purchase.
Air Mattress ( Anti-decubitus Mattress)

    No.8002+A     No.8018+A     No.8020+B
         Others

 

 

Tick the box □ which is suitable for you.

Need produce information to be sent by post.      

Need e-mail address or fax No. for communication.

Need other method for communication

Please tick the box □ below for our record:
Importer   Whole Sale  Retailer   Personal  Other:

 

 

Please fill in following information
*In order to match our computer data, please fill in these in English.

Your name /Company Name (in English):

Your Name / Company Name (In Chinese):

Name of Contact Person:

 

Tel. No.: Mobile Phone:
Fax No.: E-mail:
Communication Address:    
Delivery Address:    

 

Date of application: