LEIS OF HAWAII

PLEASE CALL TO PLACE ORDER

1-808-732-7385

ARTIFICIAL SILK ISLAND LEIS

ORDER FORM

Date Ordered: Date of Service:

PLEASE CHECK ONE - SHIPPING TO BUSINESS - SHIPPING TO RESIDENCE

Company Ship To:

c/o Name:

Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

Contact Name:

How did you hear of our company?

*Artificial - Single Tuberose & White Carnation Lei*

STK# ASIL #0001 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Single Tuberose & Red Carnation Lei*

STK# ASIL #0002 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Single Tuberose & Orange Carnation Lei*

STK# ASIL #0003 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Single Tuberose & Pink Carnation Lei*

STK# ASIL #0004 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Single Tuberose & Purple Carnation Lei*

STK# ASIL #0005 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Single Mokihana Lei*

STK# ASIL #0006 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Double Ohi'Ali'i Orange Lei*

STK# ASIL #0007 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - Double Ohi'Ali'i Orange & Mokihana Lei*

STK# ASIL #0008 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

Qty () X

TOTAL = $

*Artificial - 6 Strand Pikake Lei*

STK# ASIL #0009 - LEI - DESCRIPTION - COLOR - #PK - EACH - TOTAL

NANI ~ 8720514012

Qty () X

TOTAL = $

NO MINIMUM ORDER

Each pack must be purchased as a whole. No broken packs.

One pack contains: 6 leis in each pack.

PRICES: Prices are subject to change.

MERCHANDISE CLAIMS and RETURNS:

SHIPPING INFORMATION and CHARGES:

Prefer United Parcel Post. Federal/Express optional.

Please Indicate Below Total Amount Of Packs:

PACKING/HANDLING (Included)

POSTAL SERVICE

Postal Service:

Federal Express 2Day Service:

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SUBTOTAL $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -HI Tax 4.712% $

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL DUE $

Payment: Visa or Master Card accepted through LEIS OF HAWAII

Credit Cards Type:

Card No:

This Credit Card Will Not Be Valid Unless You Submit Your

Last 3 Digit Numbers Located On The Back Of Your Credit Card:

Exp. Date: 00/00

Name Of Person As It Appears On The Card:

Credit Card Billing Address:

City: State: Zip Code:

Phone: Area Code - Ext: 1-800 or 888: -

Fax: Area Code - E-mail:

AVS (Address Verification Service

When complete, click "submit" to email Leis Of Hawaii. If you wish to have a hard copy of your order, please print "Form Confirmation" page after submitting. Please allow processing time. You will be contacted by your email below once your Credit Card has been approved, which will confirm your order. You will be contacted by your email if there is any problem with your order.