[Omakase-Factory] FAX +81-55-962-1768　　　　　Fax Order Sheet For A4 size
Item* Quantity* Price* The fare is an EMS rate.
We will report the total amount with E-mail or FAX. Consumption tax (5%) of Japan is levied.
[An orderer]*　　[*A required item]
NAME*

ZIP CODE*
ADDRESS*


E-mail*
TEL*
FAX*
[An address of the delivery future]←It enters when differing from the person who orders.
NAME

ZIP CODE
ADDRESS


TEL
[PAYMENT]*
[Credit card company]
ＶＩＳＡ ＭＡＳＴＥＲ
[Credit card number] ---
[Term of validity] /(mm/yy)
[Name on the card]
[Reports from customer]