Green & Gold International Exports

Rm 208 Solmac Bldg, 84 Dapitan St., SMH 1114 Quezon City, Philippines

Tel. Nos.: +63(2) 415-8714; 416-2951; 781-0069

Fax Nos.: +63(2) 415-8715; US Fax no. +1(800) 559-2595; UK Fax no. +44 (207) 900-2636

Email:

ORDER FORM FOR CHINA NO. 1

Date:

QUANTITY /
PRODUCT DESCRIPTION
/ UNIT PRICE / TOTAL
Set/s / SUPER Tian Xian Liquid, 60 vials x 20 cc/vial / US$1,588.00/ Set
Set/s / Tian Xian Liquid, 60 vials x 20 cc/vial / US$1,388.00/ Set
Box/es / Super Tian Xian Liquid (20 vials x 20cc) / US$ 540.00/ Box
Box/es / Tian Xian Liquid (20 vials x 20cc) / US$ 470.00/ Box
Box/es / Tian Xian Suppository, 12 pcs/box / US$80.00/Box
Box/es / Tian Xian Capsule No. 1, 180 pcs/box / US$150.00/Box
Box/es / Tian Xian Capsule No. 3, 180 pcs/box / US$150.00/Box
Box/es / Tian Xian Capsule No. 5, 180 pcs/box / US$150.00/Box
Box/es / Tian Xian Capsule No. 6, 180 pcs/box / US$150.00/Box
Box/es / Tian Xian Capsule No. 7, 180 pcs/box / US$150.00/Box
Box/es / Tian Xian OSTITIS, 240 pcs/box / US$90.00/Box
TOTAL TIAN XIAN PRODUCTS ORDERED / US$
SHIPPING AND HANDLING / If total amount of Tian Xian products order is equivalent to MORE THAN US$400.00 / US$ 0.00 / US$
If total amount of Tian Xian products order is equivalent to LESS THAN US$400.00 / US$ 50.00 / US$
OTHERS (NON-TIAN XIAN PRODUCTS):
QUANTITY /
PRODUCT DESCRIPTION
/ UNIT PRICE
TOTAL NON-TIAN XIAN PRODUCTS ORDERED / US$
SHIPPING AND HANDLING / Shipping fees will be charged on non-Tian Xian products, depending on the weight (actual or dimension – whichever is higher) of the package. / US$
BANK SERVICE CHARGES (Please inquire with your bank regarding the bank transfer charges, and add this to the amount you will transfer.) / US$
TOTAL AMOUNT DUE : /
US$

IMPORTANT: Customs duties and taxes that may be charged at the port of entry shall be shouldered by the consignee.

SHIPPING INFORMATION

Name
Delivery Address

City/ State/ Zip Code

/ Country

Phone / Fax

/ E-mail Address

BILLING / CREDIT CARD INFORMATION

Cardholders’ Name

/ Credit Card Type
(Visa/ MC/ AMEX)

Card Number

/ Expiry Date

Name of Bank that Issued the Credit Card

/ Credit Card Code**

Billing Address

/ This is the address where your bank sends your credit card’s billing statement. ***

City/ State/ Zip Code

/ Country

** The credit card code pertains to the last 3 digits printed at the back of Card (in the Signature Panel) for Visa/ Mastercard. For AMEX, this is the 4 digit code printed in front of the credit card.

PAYMENT BY TELEGRAPHIC TRANSFER

IMPORTANT: Please be advised that all charges are for the sender's account. Please kindly add the bank service charges to the amount you will transfer.

The shipment will not be sent out unless the complete amount (total product cost + shipping charges + bank transfer charges) is received.

Please find below our bank details

ACCOUNT NAME / GREEN & GOLD INT’L EXPORTS
ACCOUNT NUMBER / 101-719391-2
BANK / China Banking Corporation
BANK ADDRESS / Dasmarinas cor J. Luna St., Binondo, Manila, Philippines
SWIFT CODE / CHBKPHMM

It is important to inform your bank to indicate on the bank transfer "INTERBANK SETTLED AMOUNT US$______".

Once transfer has been made, please send us a fax copy of the transfer, your order and shipping details (i.e., name, telephone number, complete address, email, etc.) to +63 (2) 415 8715 or to +1 (800) 559 2595.

You can also scan and e-mail a copy of the transfer, your order and shipping details (i.e., name, telephone number, complete address, email, etc.) to .

PAYMENT BY WESTERN UNION / XOOM / MONEYGRAM

INSTRUCTIONS FOR TRANSFER

In favor of / MANUEL KIOK
Address / RM. 208 SOLMAC BLDG., 84 DAPITAN COR BANAWE ST. Q.C. 1114 PHILIPPINES
Telephone Number / +63 (2) 415 8714

Once remitted, please inform us the following details:

SENDER's

COMPLETE NAME

/ (First Name) / (Middle Name) / (Last Name)

COMPLETE ADDRESS

TELEPHONE NUMBER

EXACT AMOUNT

MTCN or

CONTROL NUMBER

Fax Bank receipt to +63 (2) 415 8715 or +1 (800) 559 2595. And email the reference or MTCN no.

For more information about our products or to order online

please visit http://www.cancerherbal.com

You can send your inquiries to

You can call our Philippine office at +63 (2) 415 8714.

Philippine office hours are:

9AM – 5:30PM (GMT +8:00), Mondays-Fridays

9AM – 3PM (GMT +8:00), Saturdays.