Order Form

Name: (First Name, Middle Initial, Surname)
Mode of Payment:	Smart Money/Smart Pera Padala Paypal Alertpay
Email Address:

Form provided by Freedback.

Order Form

Name:
Contact Number:
Postal Address:
Email Address:
PACKAGE	Option 1 (200 PHP) Option 2 (500 PHP)
Mode of Payment	Smart Money to Smart Money Smart Pera Padala - Smart Money
Date of Payment:

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