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訂購表格[ORDER FORM](香港地區使用) 請填寫所有*部分。

＊	貨品編號	貨品名稱	顏色	數量	購買價
	OTA - 24	LOVELESS x T9G x MEDICOM TOY MONSTER			$ 1,220
	OTA - 39	Crystal Ball by PREMIUM BOOK Vol.3			$ 380
	OTA - 58	lucien pellat-finet Skull Umbrella	black		$ 720
	OTA - 91	Hysteric Glamour Fuck Bear	white		$ 980
	OTA - 110	WWF x ISETAN BE@RBRICK 50% Charity Strap			$ 50
	OTA - 115	LEILOW HAWAII BE@RBRICK （ TTF Ver. ） 100%			$ 180
	OTA - 145	ISETAN 09 Limited Charity 50% BE@RBRICK Strap			$ 60
	OTA - 154	BE@RBRICK x BMW 100%	blue		$ 260
	OTA - 169	roar 3rd Anniv. Limited Tumbler	black		$ 280
	OTA - 179	MEDICOM TOY x radius iPhone 4 Back Cover			$ 280
	OTA - 180	Merry Green Christmas BE@RBRICK Strap 50%	green		$ 50
	OTA - 181	Merry Green Christmas BE@RBRICK Strap 50% [ Silver ]	silver		$ 60
	OTA - 187	MEDICOM TOY SOFT VINYL KUM@BRICK-1	black		$ 380
	OTA - 188	BE@RBRICK silicone case for iPhone 4/4S			$ 380
	OTA - 189	MEDICOM TOY BE@RBRICK & KUBRICK CASE	clear		$ 30
	OTA - 190	MEDICOM TOY BE@RBRICK & KUBRICK CASE BOX [ 20 PIC ]	clear		$ 450
	OTA - 191	MEDICOM TOY VALENTINE LIMITED BE@RBRICK 100%	pink		$ 220
	OTA - 194	MEDICOM TOY 2007 X'MAS LIMITED BE@RBRICK 70%	black		$ 480
	OTA - 195	MEDICOM TOY 2008 X'MAS LIMITED BE@RBRICK 70%	silver		$ 480
	OTA - 196	MEDICOM TOY 2009 NEW YEAR LIMITED BE@RBRICK 70%			$ 480
	OTA - 197	MEDICOM TOY 2010 NEW YEAR LIMITED BE@RBRICK 70%			$ 480
	OTA - 198	MEDICOM TOY 2011 NEW YEAR LIMITED BE@RBRICK 70%	white		$ 480
	OTA - 199	STUSSY WORLD TOUR 2006 LIMITED BE@RBRICK 100%	black		$ 280
	OTA - 200	2009 STUSSY LIMITED BE@RBRICK 100%	white		$ 280
	OTA - 203	STUSSY HOLIDAY CHEER BEAR 2008			$ 280
	OTA - 204	KUBRICK STARWAR "Darth Vader" 100%			$ 780
	OTA - 205	KUBRICK STARWAR "Anakin Skywalker" 100%			$ 780
	OTA - 206	KUBRICK STARWAR "Spirit of Yoda" 100%			$ 780
	OTA - 213	ONE LOVE BE@RBRICK 70%			$ 50
	OTA - 214	BE@RBRICK back cover for iPhone 4	bk,chrome		$ 380
	OTA - 217	BE@RBRICK BICYCLE Playing Cards Poker Set			$ 280
	OTA - 218	FABRICK x Warner Bros Crown Slippers [ LL size ( 26.5 ~ 28 cm ) ]	white		$ 380
	OTA - 223	SUPREME x LADY GAGA Poster			$ 1,480
	OTA - 224	ISSEY MIYAKE 10th Ann Tokujin Yoshioka [O] Watch	smoke		$ 2,580
	OTA - 225	MEDICOM TOY 15th Anniv. KUM@BRICK	clear		$ 490
	OTA - 226	MEDICOM TOY MY FIRST B@BY [ Black Ver. ] 1000%	black		$ 2,980
	OTA - 227	MEDICOM TOY 15th Anniv. MY FIRST B@BY 1000%	white		$ 4,180
	OTA - 231	Porter x Nikon Karabiner Set	bk,yellow		$ 150
	OTA - 232	MEDICOM TOY MANUAL VOLUME II			$ 690
	OTA - 233	kiss the earth x ISETAN BE@RBRICK Strap [ Forest Green Treefrog ]	type 2		$ 60
	OTA - 234	MEDICOM TOY Real Action Heroes STAR WARS Darth Vader	black		$ 1,280
	OTA - 238	TOKYO SKYTREER BE@RBRICK 100%	blue		$ 380
	OTA - 239	MEDICOM TOY 2011 HALLOWEEN BE@RBRICK	black		$ 260
	OTA - 241	ISETAN 125th Anniv. Limited Happy BE@RBRICK “i”			$ 160
	OTA - 246	BE@RBRICK WORLD WIDE TOUR 2 [ MICKEY MOUSE 100% ]			$ 220
	OTA - 248	Merry Green Christmas BE@RBRICK Strap 50%			$ 60
	OTA - 251	MY FIRST BE@RBRICK B@BY ( 15th Anniv. Ver ) 100%	white		$ 250
	OTA - 252	MY FIRST BE@RBRICK B@BY ( 15th Anniv. Ver ) 400%	white		$ 940
	OTA - 253	BE@RBRICK CHOGOKIN LOVE BIANCO 200%	white		$ 980
	OTA - 254	BE@RBRICK WORLD WIDE TOUR 2 [ TOKIDOKI 400% ]	multi		$ 890
	OTA - 255	Tokyo Marathon BE@RBRICK 100%	black		$ 240
	OTA - 258	2012 Valentine BE@RBRICK 100%	pink		$ 220

交易地點* : 地鐵沿線 / 郵寄
# 選擇地鐵沿線交收者,貨品價格如低於港幣$500，我們不接受面交 #
# 選擇[親臨到【cotwo】取貨]只會為客人預留貨品2天 #

付款方法* :

# 選擇[親臨到【cotwo】取貨]可用 EPS 或信用卡付款 #

顧客資料

顧客名稱* : 中文或英文全名

聯絡電話* :

電郵地址* :

註備 : (選擇郵寄者請填寫地址)

送出前，請閱覽本網店訂購條文(introduction)。

此表格會經用戶的Microsoft Outlook或Outlook Express送出，如果閣下正在使用的電腦中沒有安裝及設定Microsoft Outlook或Outlook Express，請以電郵的方式將以上內容電郵至 [ order@head-porter.org ] 。

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