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ORDER FORM FOR
"WILD VIOLET OF
JAPAN"
with autography of the author
Please fill in this form, print out, and send to the following post-address
with money.
PRICE= 25 US $ including postage
Money order or cash of local currency are
available.
Please be sure to send by Recorded delivery.
Credit card isn't available. We send by SAL.
Go
to Available local currency and prices
| Name: |
| Address: |
| City: |
State: |
| Zip: |
Country: |
| E-mail: |
| Fax: |
| Number of copies: |
| Price(25 US$/1copy
including postage): |
| Sum of amount: |
Receiver:
OFFICE MAPLE
17-2 Ushikawayakushi, Toyohashi-shi, Aichi-pre. Japan Zip=440-0015
phone:81-532-55-6080 fax: 81-532-55-6081
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