TRUNG TÂM HOA VÀNG CREDIT CARD FORM

Please Fill Out This Order Form, PRINT, and Fax It to us With Our Fax Number:

TRUNG TÂM HOA VÀNG
275 E Taylor St.
San Jose. CA. 95112
Phone: (408)971-2551
Fax: (408)569-9055

Your Name:
Credit Card #:    Expiration Date (MM/YY):
Your Address:    Apt:
 City:    State:     Zip Code:
Your Phone: - -
Your Email:

Quantity

Product Title

Product Price

Shipping/Handling:
 Flat rate: $2.99 USD
Total:

PLEASE PRINT - Email: phammanhdat@hotmail.com