gift cards

ORDER FORM

Please fill out the form and click submit botton.
Fields marked with an asterisk(*) are requird.

NAME*	FIRST NAME： LAST NAME：

ZIP CODE*

PREFECTURE*

ADDRESS*	*If shipping to a business, the company name must be entered or shipments may be delayed.

TEL* *Local number in Japan only	- -

E-MAIL*

RE-ENTER E-MAIL TO CONFIRM*

¥2,500 × (qty)

Total : ¥

CREDIT CARD

*We accept VISA / MASTER card only.
*The link to credit card payment will be sent to your e-mail address after submission.

BANK TRANSFER

Bank Information
Sumitomo Mitsui Banking Corporation
Hamamatsucho Branch
Saving Account 2833229
OM2 Dining Co., LTD.

Any fee regarding bank transfer will be your cost.
Bank information will be sent after sending the order form.

(1) NAME*:

(2) DATE OF BANK TRANSFER*:

YES

Please indicate the name on the Receipt.

YES

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Another address (JAPAN ONLY)

NAME*	FIRST NAME： LAST NAME：

ZIP CODE*

PREFECTURE*

ADDRESS*	*If shipping to a business, the company name must be entered or shipments may be delayed.

TEL* *Local number in Japan only	- -

E-MAIL

RE-ENTER E-MAIL TO CONFIRM

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