Customer Name            Phone 

E' mail                           Fax

Address

   I will submit Card Info with the Order Form  ( Second Submit )       Phone in my Card Info     

Recipient Name            Phone 

Address

Message            

1 -Bouganvilia Lei.............................$12.75        Quantity

2-Azalea Lei....................................$4.75         Quantity

3- Lantern Ilima Lei...........................$6.75        Quantity

4 -Ginger Shell Lei ...........................$12.75       Quantity

5- Double Carnation Lei ...................$10.75       Quantity

6- Double Carnation Lei...................$12.75        Quantity

7 -Double Orchid Lei .......................$12.75       Quantity

8- Hula Lei.......................................$3.75         Quantity

9 -Candy Lei.....................................$3.75        Quantity

10-Seed Lei ....................................$4.75          Quantity

11-Kukui Nut Lei ( brown ).............$9.75          Quantity

12-Kukui Nut Lei ( cream ).............$9.75          Quantity

13-Kukui Nut Lei ( black )..............$9.75          Quantity

14-Kukui Nut / mc..........................$15.75         Quantity

15-Kukui Nut / Shells......................$17.75         Quantity

16-Aloha Shirt  ...............................$19.75      Quantity

Note: Color choice is available upon request only and Silk Lei price will be double or triple.

Select order process option    1, Proceed the substitution ( equal value only ) if it is necessary. 2, Cancel the Item if a substitution is occur, ship out the remain Item. 3, No substitution (Item Price X 2 or 3 )and will call to confirm on daily base. 4, Cancel my entire order.

Ship Out Date             January February March April May June July August September October November December         1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31      Mondays Tuesdays Wednesdays              SILK LEI GALLERY

Estimate Shipping Charge                       Box # 6 ( 1-5 single Lei )......................$19.50 Box # 10 ( 6 to 15 single Leis............$25.50 Box # 9 ( 16 to 30 single Leis ) ............$30.50    

 CARD INFO 

Example: Michael Jackson  4817-0006-2846-5000   334 3 digits on the back of your Visa or Master Cards. 

  submit Card Info with Order Form      Card Expire Date            CV Code above your signature