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
.:
1
2
3
0
= SELECTED;
x
Bottle(s)
XANGO Juice
(750ml)
€
.:
1
2
0
= SELECTED;
x
Box(es)
XANGO Juice
(4 Bottles with 750ml)
€
.:
1
2
0
= SELECTED;
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...
If you were a regular customer, you could benefit from
%
customers discount
and pay only:
€
Please, contact me and inform me about the conditions!
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
*
Fill in the code of the picture!
One moment please... Your request is in process!!
* Fields with 1 asterisk are required!
**) Rates for shipping & delivery costs are only valid within the Netherlands.
