Billing Information  Items in blue are required                                                                             

Card Holder Name      

Phone

Fax     

E' mail    This field is very important, do not let it blank   

Card Holder address     

Note: Card Holder's address must be  exact match with the Card Holder's billing address, otherwise Card will be decline.

Card No                           Expiration Date                                            CV Code

Ship out Date none Mondays Tuesdays Wednesdays      none January February March April June July August September October November December      none 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31            Event Day  none Mondays Tuesdays Wednesdays Thursdays Fridays     none January February March April June July August September October November December   none 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      

Order confirm request none 1_Please post my order confirm on your ORDER STATUS page__extra charge $4.50 2_Pleas send my order confirmation to my e mail address__extra charge $7.50 up to 10 mails 3_Please contact me by fax___Minimum charge $7.50 up to 5 transmissions 4_Please contact me by phone ___ Minimum charge $15.00 5_No confirmation and send as order request.

Yes, I authorized this online Lei order purchase and my name & phone are       

  Orchid Lei $5.79 10 Orchid Leis 15 Orchid Leis 20 Orchid Leis 30 Orchid Leis 40 Orchid Leis . 10 Ti Leaf Leis 20 Ti Leaf Leis 30 Ti Leaf Leis 40 Ti Leaf Leis . 10 orc & ti Leis 20 orc & ti Leis 30 orc & ti Leis 40 orc & ti Leis         Estimated Shipping Charge $36.50 Box # 8 ( 10 Single Leis ) $48.50 Box # 10 ( 15 Single Leis ) $55.50 Box # 9 ( 20 Single Leis ) $65.50 Box # 9a ( 40 Single Leis ) $75.50 Box # 15 ( 60 Single Leis* ) UPS Shipping Account