ORDER PRODUCTS

FIRST NAME

LAST NAME

EMAIL

MOBILE

REGION
DAR ES SALAAM MWANZA DODOMA MARA ARUSHA MBEYA TANGA

DISTRICT

WARD/ STREET

PRODUCT
RICE MAIZE FLOUR WATER DIGESTER MAGAZINE CHICKEN VEGETABLES DIGESTER
AMOUNT

INCLUDE DELIVERY:
Yes:
No:

PAYMENT METHOD
TIGO PESA AIRTEL MONEY CRDB BANK EXIM BANK
ACCOUNT NUMBER

ACCOUNT NAME