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Order Form

You can place your order here. Are you reluctant to pay over the Internet? For your sense of security, we do not use an online payment system. We will contact you, after the order is placed, to discuss further handling of the order.

 Personal data


.: Name *

.: Adress+Numbr. *
.: Postal code *
.: Residence *
.: Telephone *
.: E-mail adress *


Order

Amount Product Price      
.:  x Bottle(s) XANGO Juice (750ml)  € 
.:  x Box(es) XANGO Juice (4 Bottles with 750ml)  € 
.:  x Box(es) XANGO Singles (3 x 30 Singles with 30ml)  € 
** Shipment:    € 
Total:  
 € 

Discount Unfortunately we can’t give any discount on single bottles! But...

Payment


     I will pick up my order and pay cash
     Send me the order, I will transfer the money

Extra


.: Message to
    send along
 

.: Anti  Spamcode *

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*  Fields with 1 asterisk are required!
**) Rates for shipping & delivery costs are only valid within the Netherlands.