AgarPrime Order Form

👤 Personal Information

First Name * Required

Last Name * Required

Email Address * Valid email required

Phone Number * Required

Street / House No. * Required

Barangay * Required

City / Municipality * Required

Province * Required

Region

Country

📦 Order Details

Quantity (liters) * Minimum order is 2 liters

Price per Liter ₱2,500.00

Subtotal ₱5,000.00

Shipping Fee₱150 per kg • 1 liter = 1 kg ₱300.00

Total Amount ₱5,300.00

Subtotal + Shipping Fee

🚚 Shipping fee applies: ₱150 per kg. Since 1 liter = 1 kg, your shipping fee is ₱150 × quantity. Already included in the Total Amount above.

💳 Payment Instructions

GCash

NameJoel Ngo

Number09177280005

PSBank

NameJoel Ngo

Account #173111024572

ⓘ Upload your payment screenshot below after sending.

📎 Proof of Payment *

📤

Click to upload your payment screenshot

JPG, PNG, or PDF • Max 10MB

⚠ Proof of payment is required before submitting.

✅ Order submitted successfully! Please check your email for your order confirmation.