To: sales@tsubaya.com Subject: I want to Order ! _________________________________________________________________________________________________________ Today:@________day ________month ________year Email : _______________________________________ Name : ______________________________________ Address : __________________________________________________________________________________ Phone : _____________________________________ Fax : _________________________________________ Receiver's Name : ________________________________________________ Receiver's Address : ________________________________________________________________________________ Request : _____________________________________________________________________________________________ Order : (Example / Product : Saruminomonaka 10@@Quantity : 2 j Product : _________________________________________@Quantity : _________________________________ Product : _________________________________________@Quantity : _________________________________ Product : _________________________________________@Quantity : _________________________________ I want to recieve :@________day ________month ________year QQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQQ TSUBAYA 383 Hirata IGA-shi Mie pref. JAPAN Email:sales@tsubaya.com URL:http://www.tsubaya.com TEL:0595-47-0029 FAX:0595-47-0075