Order Form

Name:
Email Address:
Phone Number
Delivery Method	Self-PickupPos EkspressPos Laju
Collection Date (Leave blank if you prefer to receive your edible image by post)	Select Date
Pickup Location (Leave blank if you prefer to receive your edible image by post)
Delivery Address
Expected Date to Post (Leave blank if you prefer to self-pickup your edible image at our pickup location)	Select Date
Image request	Cik Ayu's Gallery Your Own Image (please email your image to ayuedibleimage@gmail.com)
Order Description (e.g. Ordering Template: OT08; Image Code: BE01; Quantity:1)