Massage Pillow Inquiry/Order Form

*: required fileds

Item Number	Description	*Quantity	*Delievery Method
C-8601	Neck Roll		By Sea	By Air	FOB	CIF
C-8620	Vibra Rest		By Sea	By Air	FOB	CIF
C-8645	Pulsating Massage Pillow		By Sea	By Air	FOB	CIF
C-8651	Single Speed Massage Pillow		By Sea	By Air	FOB	CIF
C-8670	Ultra Comfort		By Sea	By Air	FOB	CIF
C-8672	Twin Vibrator Ultra Comfort		By Sea	By Air	FOB	CIF

*Type of Payment:
    T/T   IRR.L/C    Bank draft    Cash    D/A    D/P    Other

*This is for: Inquiry Order

Please Provide Us Your Infomation

	Orgniazation:
*	Full Name:
*	e-Mail Address:
*	Telephone Number:
	FAX Number:
*	Complete Address:
*	Country:
	Bank Reference:
	Bank Phone Number:
	Order Details/Comments