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Name:
Age:
Gender: Male Female
Contact number: (preferably mobile phone number)
Home add:
Email add:
Type of Winter white: Normal winter white ($7) Pearl winter white ($10)
Quantity: 0 1 2 3 4 5 6 7 8 9 10++
Male: 0 1 2 3 4 5 6 7 8 9 10 Female: 0 1 2 3 4 5 6 7 8 9 10
Collection place: Kovan MRT AMK MRT Bishan MRT Khatib MRT
Other place: Please type in the suitable location (Notice: A nominal fee of $5 will be charge for delivery to other location)
Date of collection: 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 01 02 03 04 05 06 07 08 09 10 11 12 / 2003 2004 2005 (dd/mm/yy)
Time of collection: 1 2 3 4 5 6 7 8 9 10 11 12 : 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 am pm
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