D'mart Delivery Order Form
Product Items
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Pokka Packet Drink - Ice Peach Tea
250 ml
$
0.50
SGD
Quantity
0
1
2
3
4
Pokka Packet Drink - Ice Lemon Tea
250 ml
$
0.50
SGD
Quantity
0
1
2
3
4
Pilot BLRTFR5 Frixion Clicker Ball Pen 0.5mm (Green Ink) (1 pc)
$
2.50
SGD
Quantity
0
1
Pilot BLRTFR5 Frixion Clicker Ball Pen 0.5mm (Blue Ink)
$
2.50
SGD
Quantity
0
1
Naspac Jelly with Nata De Coco Cup - Mixed Fruit (1 pc)
108g
$
0.60
SGD
Quantity
0
1
2
3
Mamee (BBQ) (1 pkt)
Mamee Noodle Snack - BBQ
$
0.20
SGD
Quantity
0
1
2
3
4
5
Hello Panda (Strawberry/ Chocolate) (1 pkt)
Meiji Hello Panda Biscuits - Strawberry/ Chocolate
$
0.70
SGD
Quantity
0
1
2
3
4
5
Flavour
Strawberry
Chocolate
Fairprice potato chips (1 pkt)
Original / Sour cream/ Truffle/ Seaweed/ Hot & Spicy
$
1.00
SGD
Quantity
0
1
2
3
4
Flavour
Original
Sour cream
Seaweed
Truffle
Hot & Spicy
Myojo - Chicken (Soup)
Myojo Quick Cup Noodles - Chicken
$
1.10
SGD
Quantity
0
1
2
3
4
Myojo - Tom Yum (Soup)
Myojo Quick Cup Noodles - Tom Yum
$
1.10
SGD
Quantity
0
1
2
3
4
Amount selected
Order can't be over 4.00 SGD.
What is your name?
*
Full Name
Which Year are you from?
*
Year 1
Year 2
Year 3
What is your class? (Year 1)
*
Please Select
LP1A
HS1A
HS1B
HR1A
HR1B
RO1A
RO1B
FB1A
FB1B
FB1C
What is your class? (Year 2)
*
Please Select
LP2A
LP2B
HS2A
HS2B
HR2A
HR2B
RO2A
FB2A
FB2B
FB2C
What is your class? (Year 3)
*
Please Select
HS3A
HS3B
HR3A
HR3B
RO3A
RO3B
FB3A
FB3B
FB3C
Please select the delivery type
*
Pick Up
Approximate Pick Up Date
-
Month
-
Day
Year
Date
Thank you for shopping with D'Mart!
Order Now!
D'Mart @ Delta Senior School
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