ICP Shop: Order Form

CUSTOMER DETAILS

Your Name*:
---Dr.Mr.Mrs.Ms.Prof.

Your E-mail Address*:
The staff may contact you in case there is a discrepancy in your payment and/or purchase.

YOUR PURCHASE

Class of 2019 Commemorative Shirts
Shirt: ---Chemist Na Ako 2019ChemTech Na Ako 2019 Size: ---SMLXLXXL Quantity: 012345678910

Shirt: ---Chemist Na Ako 2019ChemTech Na Ako 2019 Size: ---SMLXLXXL Quantity: 012345678910

Oath-Taking Shirts

Shirt: ---Chemist Na AkoChemTech Na Ako Size: ---SMLXLXXL Quantity: 012345678910

Shirt: ---Chemist Na AkoChemTech Na Ako Size: ---SMLXLXXL Quantity: 012345678910

Reactions Shirts
Shirt: ---Reactions OMGReactions HEY BROReactions HEY SISReactions HEY BABEReactions I LV U Size: ---SMLXLXXL Quantity: 012345678910

Shirt: ---Reactions OMGReactions HEY BROReactions HEY SISReactions HEY BABEReactions I LV U Size: ---SMLXLXXL Quantity: 012345678910

Shirt: ---Reactions OMGReactions HEY BROReactions HEY SISReactions HEY BABEReactions I LV U Size: ---SMLXLXXL Quantity: 012345678910

Shirt: ---Reactions OMGReactions HEY BROReactions HEY SISReactions HEY BABEReactions I LV U Size: ---SMLXLXXL Quantity: 012345678910

Shirt: ---Reactions OMGReactions HEY BROReactions HEY SISReactions HEY BABEReactions I LV U Size: ---SMLXLXXL Quantity: 012345678910

PAYMENT AND DELIVERY DETAILS

Payment Method Used*: ---Bank Deposit (Cash)Online Transaction

Upload your machine-validated deposit slip here*:

JPG / PDF / PNG file only. Maximum size: 1 MB.

Amount Paid (PHP)*:
Amount as reflected on your deposit slip.

Payment transaction code*:

Payment Date*:
Day: Month: ---JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC Year:
Date of transaction as reflected on your deposit slip.

Mode of acquiring the order*: ---Luzon / Metro Manila Delivery (+100 Pesos)Visayas / Mindanao Delivery (+150 Pesos)Pick up at ICP head office (FREE)
Note: for delivery, the delivery fee must already be included in your payment.

Delivery Address*: