NIKKEN PHILIPPINES, INC.  
JMT Corporate Condominium, Suite 10B
27 ADB Avenue, Ortigas Center, Pasig City, Metro Manila 1605
General Distributor Inquiry:         Tel. No.: 02-633-8734
                                               Fax: 02-634-6269
Order Entry w/in Metro Manila:     Tel. No.: 02-637-0195
Outside Metro Manila (toll free):  Fax: 1-800-1-888-6562		 Training
Order
Form
DISTRIBUTOR INFORMATION

Nikken ID Number
()  -
Evening Phone		 ()  -
Daytime Phone		 ()  -
Fax Number

Name (Last, First, Middle)

Mailing Address (No PO Box Allowed)

City
Province
City
Postal Code
CODE DESCRIPTION QTY DATE
REQUESTED		 PRICE TOTAL
8010   HBM Training            
  HBM Training (Spouse)            
8004   Gold Training            
8409   International Business
  Certification (IBC)		            
CLASS INFORMATION
  Silver Training Schedule:
     1st Day: 8:59am to 8:00pm  
     2nd Day: 8:59am to 6:00pm
  Gold Training Schedule:
     1st Day: 8:00am to 7:00pm  
     2nd Day: 8:00am to 7:00pm
     3rd Day: 8:00am to 7:00pm
                      (7:30pm to 9:30pm is                       Business Training or                       Wellness Preview)
     4th Day: 8:00am to 2:00pm
  Location
 Requested:		  
  Date
 Requested:		  
Print Name(s) of Attendee(s) as should
be written on graduation certificates:
METHOD OF PAYMENT
 Cash     Amount: 
 Check Check No.: 
      Bank Name: 
      Amount: 
 Bank Deposit Date: 
      Amount: 
      Bank Deposited to: 
 VISA  MasterCard  RCBC/JBC
 UniCard  Diners  BPI Express
      Other (pls specify): 
      Bank Name: 
      Credit Card No.: 
      Expiry Date: 
      Authorization No.: 
      Amount: 
      Cardholder Name: 
      Signature: 
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