logo_tvfanshopping_150.jpg (4852 バイト)

 

ORDER FORM

Customer's Information

Name

 
Address  
City/State/Zip:  
E-mail:  
Telphone:  

 

Japanese Names for Babies
   Description Qty. Price Subtotal
Japanese Names for Babies $13.50

Total:

 

Your Child's Name in Japanese Calligraphy
    Description Qty. Price Subtotal
Type A (14X11) $45.00
Type B (11X14) $45.00

 

Total:
   
1st Girl 2nd Girl 3rd Girl Other:
1st Boy 2nd Boy 3rd Boy Other:
Baby's Name:  
Birth Date:  
Registered Date:  
Father's Name:  
Mother's Name:  

 

Payment Information

Payment:

  Credit Card 　Check　　Money Order
Card:  
Card Number:  
Expiration:   Month /Year

Please make a check or money order and send to:

TV Fan Company
P.O. Box 49202
Los Angeles, CA 90049
USA