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Name:
Email Address:
Contact No:
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Order Request: Apple Pink Lady
Apple Green
Kiwi Zespri Green
Kiwi Zespri Gold
Grapes Autumn Royal
Orange Sunkist
Quantity (per box) 1
2
3
4 and above
Type of payment : Cash
Cheque
Online Banking
Others
Proof of payment :
contact no : +601115674642
email : chocotopp@gmail.com
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