Order Form

03:15 | Posted by kashkosh | | Edit page





Name:



Ic Number



Contact Number



Email Address:



Address



Shoes Brand
Converse

Adidas

Lacoste

Colour
Black

Blue

Red

Purple

Green

Brown

Charcoal

Blue/white

Size (U.S)
6

7

8

9

10

11

Shoes Model (converse only)



Payment Method
Cash

Bank-In

cheque

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