Le-Noble Head Office         FAX ORDER SHEET
※Office Use Only
Order Date:_____(dd)_____(mm)_____(yy)

Customer Information ※Please write down your full name.

Name:

Address:
Zip Code: 〒　　　     −　　

Phone#:

 Fax#:
E-Mail:

Delivery address: JAPAN ONLY ※(if different)

Name:

 Phone#:

Address:
Zip Code: 〒　　　     −　　

Order Items ※Free Delivery Charge on Orders Over 20,000yen. (Not-included consumption tax of 5% in total)

Item No.  /  Item name

Quantity

Gift Wrap Service

                              /

 　

none　　 ribbon

                             /

 　

none　　 ribbon

                             /

 　

none　　 ribbon

Delivery Schedule

unnecessary     FAX     E-mail
Preferred Delivery Date 　　　(dd)　　　(mm)    not specified

Preferred Delivery Time

     not specified  (9:00-12:00)　(12:00 -16:00)
                (16:00-19:00) (19:00-22:00)

Payment Information: CREDIT ONLY

Card Type: VISA      MASTER      JCB      AMEX　←Please circle your card type.
Expiry Date:_______/_______(mm/yy)
    Card #: (_______)-(_______)-(_______)-(_______)
Card Holder's Name:                                                                                  Please print
Signature:                                                         

Remarks:
Please print this form and send it to FAX #: 075-957-7557