PRODUCT PURCHASES

Complete Name:
Email Address:
Contact Number(s):
MAILING ADDRESS:
PRODUCTS YOU WANT TO PURCHASE?
FERN-C ( 750php / box )	1 box 2 boxes 3 boxes 4 boxes 5 boxes more than 5 X
FERN-Slim ( 750 php / box )	1 box 2 boxes 3 boxes 4 boxes 5 boxes more than 5 X
FERNCOFFEE (1 bag = 700 php / 2 pouches )	1 bag 2 bags 3 bags 4 bags 5 bags more than 5 X
FOR BULK PURCHASES ( MORE THAN 5), PLEASE INDICATE PRODUCTS AND AMOUNT:
DATE OF PAYMENT: ( Within 7 days upon submission of this form )
MODE OF PAYMENT:	ML KWARTA PADALA WESTERN UNION METROBANK ACCOUNT CEBUANA LHUILLER
We want to hear from you!
Who introduced you to FERN?
Is it your first time to purchase from our products?	Yes, its my first time. No, i have been a FERN user.
If you have been our consumer for quite some time now, which of our products do you like the most?	FERN-C FERN-Slim FERNCOFFEE
Do you want to be a member of FERN?	YES NO
ANY COMMENTS/ SUGGESTIONS?
Thank you for purchasing our FERN PRODUCTS! PLEASE WAIT WITHIN 24 hours FOR OUR CONFIRMATION UPON YOUR SUBMISSION OF FORM. If you want to be a FERN MEMBER, just click on the CONTACT US tab above, and we would be glad to help you! Hope to hear from you again!

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