Smokers Tea Form Page – Dabatech

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NOTE: If you are not financially ready or will not be available to pay and collect the product within 24-48 hours, please do not fill the form, thanks.

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Name *

First

Last

OF NUMBER NUMBER

COUNTRY *

STATE *

TOWN/VILLAGE ADDRESS *

PHONE NUMBER *

ALTERNATIVE PHONE NUMBER

NUMBER OF PACKS NEEDED ( SMOKERS TEA ) *

Buy 1 pack = 15,500 CFA
Buy 2 packs = 26,000 CFA Preferable
Buy 3 packs = 37,000 CFA Recommended
Buy 4 packs = 45,500 CFA Best

GENDER *

MALE
FEMALE