Order Form
* = Required Field

E_mail*: Phone:
Full Name*: State:
Address*: Zip Code:
City*: Country*:

Please make sure the color and size you select are available for each item you order.
Add 25% per item for special color orders.

Item Name
Size:
Color:
Price: $
Quantity:
    
1. x =
2. x =
3. x =
4. x =
5. x =
6. x =
Shipping ($15 USD for the first item, $7.50 USD for each additional item)  
(All items sent via registered mail with deilvery confirmation) :
Total:

Payment Options: Visa   Mastercard   Amex
Card Number:
Expiration Date: (mm/yy)

 I would prefer to fax my credit card information to Maogany - (590) 99 55 69

       If you would like to discuss other payment options please contact Maogany

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