Online Marketplace (Product Order Form)

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Online Marketplace

Product Order Form

1
Terms and Conditions* This field is required.
2
Are you new or old customer?* This field is required.
New
Old
3
Full Name* This field is required.
First Name
Last Name
4
E-mail* This field is required.
5
Contact Number* This field is required.
Country Code
Area Code
Phone Number
6
Birth Date* This field is required.
Month
Day
Year
7
Take a photo of you with your valid ID * This field is required.
8
ID Card No. * This field is required.Kindly indicate at least one (1) of your valid ID Card No. Please take note that you must submit the same ID on the next identity verification process.
Kindly indicate your valid card number. Format should be, ID Card: ID Card No.
9
Billing Adress* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Philippines
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
10
Is shipping address same as billing address?* This field is required.
Yes
No
11
Shipping Adress* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Philippines
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
12
Recipient's Full Name* This field is required.
First Name
Last Name
13
Your Order
prevnext( X )
My Bag
0
My Bag
Great Product Name
$20
Quantity:1
Size:Small
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Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
RemoveEdit
Great Product Name
$20
Quantity:1
Size:Small
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ORDER SUMMARY
Total costPHP
Rice (Special)
56.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
per kilogram
Subtotal: 0.00PHP
Longpin Rice
46.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
per kilogram
Subtotal: 0.00PHP
Onion (White)
75.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Onion (Red)
100.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Garlic
167.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Sili (Labuyo)
90.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Luya
115.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Bell Pepper
140.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Siling Pangsigang
60.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Ampalaya
90.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Sitaw
150.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Pechay Tagalog
75.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Talong
90.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Kamatis
85.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Repolyo
90.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Carrot
60.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Baguio Beans
100.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Patatas
100.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Pechay Baguio
70.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Sayote
75.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Broccoli
140.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Cauliflower
140.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Pipino
65.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Labanos
78.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Okra
65.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Sitsaro
182.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Toge / Mongo Sprout
78.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Mongo
145.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Sili (Leaves)
15.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per tali
Subtotal: 0.00PHP
Kangkong
15.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per tali
Subtotal: 0.00PHP
Kalamansi
120.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Mango (Carabao)
100.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Avocado
195.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Indian Mango
45.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Singkamas
65.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Orange
30.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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25
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31
32
33
34
35
36
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38
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41
42
43
44
45
46
47
48
49
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51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
per piece
Subtotal: 0.00PHP
Lemon
35.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
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31
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33
34
35
36
37
38
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40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
per piece
Subtotal: 0.00PHP
Fuji Apple
35.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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28
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31
32
33
34
35
36
37
38
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40
41
42
43
44
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46
47
48
49
50
51
52
53
54
55
56
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59
60
61
62
63
64
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68
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71
72
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76
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80
81
82
83
84
85
86
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88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
per piece
Subtotal: 0.00PHP
Century Pears
35.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
25
26
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28
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31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
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68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
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89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
per piece
Subtotal: 0.00PHP
Squid (Baby)
365.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Squid (Medium)
445.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Squid (Big)
465.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Squid (Lumot)
465.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Alimasag (Small)
415.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Alimasag (Medium - Big)
525.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Alimango (Medium)
865.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Alimango (Big)
965.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Clam (Small)
225.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Clam (Big)
265.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Oyster
165.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kiligram
Subtotal: 0.00PHP
Tahong
195.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Seaweeds (Arosep)
215.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Seaweeds (Guso)
215.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Seaweeds (Lato)
215.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Shrimp (Small)
465.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Shrimp (Medium)
545.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Shrimp (Big)
585.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Prawn (Small)
645.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Prawn (Medium)
665.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Prawn (Big)
715.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Prawn (Jumbo)
785.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilo
Subtotal: 0.00PHP
Tilapia
215.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Bangus (Big)Debone Fee Php50
255.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Bangus (Small)Debone Fee Php50
245.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Galunggong
265.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Tawilis
185.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Cream Dory
195.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
White Pampano
485.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Lapulapu (Red)
665.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Lapulapu (Black)
615.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Alumahan
345.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Sapsap
405.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Tuna (Class A - Sashimi)
545.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilos
Subtotal: 0.00PHP
Tuna (Class B - For Sashimi / Cooking)
465.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Tuna Belly (Frozen)
445.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Tuna Belly (Fresh)
485.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Tuna Jaw
345.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Tuna Tail
345.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Salmon (Steak/Fillet/Sashimi)
705.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Salmon Head (V-cut)
285.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Salmon Head (Straight Cut)
365.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilogram
Subtotal: 0.00PHP
Salmon Belly
345.00PHPEdit
Back
0
0
1
2
3
4
5
6
7
8
9
10
per kilograms
Subtotal: 0.00PHP
Total cost 0.00PHP
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