EmailMe Form - Nerdy Form <3

Nerdy Form <3
Type in your nerdy order (:

Name *

Real Name pleasee (:

Address

Fill this up only if you are opt-ing for postage (:

Street Address

Fill this up only if you are opt-ing for postage (:

Address Line 2

Fill this up only if you are opt-ing for postage (:

City

Fill this up only if you are opt-ing for postage (:

State / Province / Region

Fill this up only if you are opt-ing for postage (:

Postal / Zip Code

Fill this up only if you are opt-ing for postage (:

Country

Fill this up only if you are opt-ing for postage (:

Handphone Number. (: *

Real Number Pleasee. So we Can contact you thru sms (:

Email *

Type in the e-mail that you will check often.

Confirm *

Items *

Do state the colour, quantity and sizes (If applicable)

Payment via: *

Choa Chu Kang MRT/ LRT

Conceal Cash

Bank Transfer

Other ways.

If U click on other ways please fill in the (Other places)

Other Places For Meetups if it is not named above.

Rate the Nerdy Twins!

Awesome

Excellent

Good

Poor

Bad

Rate us! Thanks (:

Image Verification
	Please enter the text from the image: [Refresh Image] [What's This?]