Thank you for your order.
This is fax order sheet.
Please fill in this sheet, print it out
and fax it to 03-3272-0187.
You can order online if you pushed the GO botton
after you filled in this sheet.

Model Number
Model Name
Amount
Payment (Please choose how to pay.)	C.O.D (cash or credit card payment at the door) Credit Card (advance online payment) Bank Transfer (advance payment) ※If you choose credit card, we will send you back settlement guide mail of KURONEKO@Payment.
Delivery Date 　　　Delivery Time Sample
Delivery Time	Any Time Morning 12pm-14pm 14pm-16pm 16pm-18pm 18pm-20pm 20pm-21pm
Simple Wrapping（Free）	Wrapping Paper Nothing Atlas Blue Red Christmas Ribbon Nothing Red Green Yellow Pink Light Blue Gold
*If you would like greeting card, choose only one from these samples.
Greeting Card（Free）	ex) Cake
Message Content
*If you would like whole(charged) wrapping, choose the color of paper and ribbon.
Whole Wrapping (charged)	Wrapping Paper Nothing Flower Gold Lattice Silver Lattice Christmas Ribbon Nothing Red Rose Blue Green
Shipper
Name
Zip Code
Address
Telephone
Fax
E-mail
E-mail （Please fill in once again for reconfirmation.）
Opinions & Demands
Consignee (Please fill in these columns if you want to send the goods to the different place from above.)
Name
Zip Code
Address
Telephone

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