Please print this page and apply for a required matter by upper facsimile of entry!
There is no entry leak or please apply after affirmation well at the end.
Please fill in the number and the amount of money clearly legible.
(Note)
1. Please add 2000 yen to your total price and pay in advance to the following bank with which we have dealings.
2. If you fax the remittance specification to us, we will dispatch at once.
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| YAGI-shoukai FAX order sheet --- last modefied May 25, 2010 |
| * : Required |
| Name */ Age |
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| Country * |
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Zip code * |
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| City / state * |
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| Address * |
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| Phone namber * |
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| Fax number * |
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| E-mail address |
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| Items |
Price(yen) |
QTY |
total(yen) |
include tax |
| AHCC"IMUNO ACE" granule , 1.5g , 33bags |
18,900 |
. |
. |
- |
| AHCC"IMUNO GOLD" capsules , 300mg , 120capsules |
12,600 |
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. |
- |
| AHCC"KATURI" granule, 1.5g, 33bags |
18,900 |
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. |
- |
| AHCC"KATURI" capsules, 300mg, 120capsules |
12,600 |
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- |
| "PMP OXINON " capsules , 330mg , 120capsules |
10,290 |
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- |
| "SUPER FUCOIDAN" granule , 100ml , 30bags |
21,000 |
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- |
| "FUCOIDAN" granule , 1500mg , 30bags |
15,750 |
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- |
| "FUCOIDAN" capsules , 330mg , 150capsules |
15,750 |
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- |
| Sub Total |
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| Remittance Charge |
2,000 |
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| Total Order |
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