GORYO Chemical, Inc. Order Form

required item. Please be sure to fill it out.

Customer information
Please contact your local distributor for order.
If you have no distributor in your country, please order with this form.
1.Name
2.Organization
3.E-Mail
3.E-Mail (for check)
4.Phone:
5.Shipping Address Please write contact name, delivery address with zip code and country.
6.Billing Address if different from above, please wride contact name and address
7.Payment Wire Transfer : We will send you an invoice with wire transfer directions.
Pay pal ※
※Please enter your Paypal registered email address in the next box.
【Registered email address】
We will send you the Pay pal invoice to registered email address.
8.Order List 1 Code No. : Product Name : Price : Qty :
8.Order List 2 Code No. : Product Name : Price : Qty :
8.Order List 3 Code No. : Product Name : Price : Qty :
8.Order List 4 Code No. : Product Name : Price : Qty :
8.Order List 5 Code No. : Product Name : Price : Qty :
9. Comments
Thank you for your order. We will send you order confirmation.