Order Form

Order Form

Please fill out the form below.
You must complete all sections marked with an asterisk(*).

Ordered by:

Name *
Sex	Male Female
Age	year's old
Body Height	(Please don't forget to write "cm" or "inches".)
Body Weight	(Please don't forget to write "kg" or "pounds".)
Waist	(Please don't forget to write "cm" or "inches".)
Address
Zip/Postal code
Country
E-mail*
Phone*
FAX
Item# and Size of the good(s) you order. * (Click here to see our Size Cart)
Payment	VISA/MASTER CARD International Postal Money Order

*If you belong to a sect of Japanese Buddhism, please complete this section.

Name of your temple
Name of the sect and branch	Sect (Syu) Branch (Ha)
Code of your temple

*If you would like us to ship this order to a different address, please complete this section.

Ship to:

Full Name
Address
Zip/Postal code
Country
Phone number
Gift	Yes No

| Home | Back | Product Index | Free Fabric Samples | Order Form |

Specialized Samugi Store
SilkRoad Co.,Ltd
31 Teranomae-cho, Hanazono, Ukyo-ku, Kyoto-shi, KYOTO, 616-8041 Japan.
TEL: 81-75-464-2198 FAX: 81-75-464-2495
URL: http://www.kyoto-silkroad.com
E-Mail: mail@kyoto-silkroad.com