ルイボスティー【オーガニック】

※ are necessary box to fill in.

Which organic-rooibos product do you like?

Teabag Type (3.5g×70bag) 3,200 yen(a)	Please Select 1 2 3 4 5 6 7 8 9 10
Home Size (200g) 1,890 yen(b)	Please Select 1 2 3 4 5 6 7 8 9 10
Cafe and Restaurant Size (600g) 4,200 yen(c)	Please Select 1 2 3 4 5 6 7 8 9 10
Transportation : 525 yen in Japan	If it's sending to oversea, the fee fluctuates.
How would you like to pay?※	Post Office　 Pay when it arrives
Do you have a request for arrival time?※	I don't request.　 I request.
Date (If it's blank, we will send as soon as possible)※(g)	year：month：Date：
Time(h)	Please Select AM 12:00 - 14:00 14:00 - 16:00 16:00 - 18:00 18:00 - 20:00 21:00 - 21:00
Fill in your address. (If it's second time, you only need to fill in your name and phone#.)
Name※(j)
Phone #※(k)
Address※(l)	Please write the address here
E-Mail※(m)
If you would like to send at different place, fill in here.	I want to receive at different place from my house.　 I want to send it to someone else. But charge to my self.
Name(o)
Phone #(p)	--
Address(q)	Please write the address here
Message(r)	Please write the content here

Please click SEND to confirm the contents in the subsequent page before transmission.

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