JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
WEAK ERECTION SEARCH
PLEASE, SUPPLY THE CORRECT INFORMATION FOR OUR DELIVERY AGENTS TO EASILY CONTACT YOU FOR THE DELIVERY
If you know that you're not ready to receive the parcel whenever you're called by our agent, please do not fill out the order form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
FULL NAME
*
Your answer
DATE OF DELIVERY
*
The parcel should be processed immediately
Required
Email Address
*
Your answer
DELIVERY ADDRESS
*
Your answer
STATE/CITY
*
Your answer
PHONE NUMBER
*
Your answer
WHATSAPP NUMBER
*
Your answer
COUNTRY
*
SOUTH AFRICA
ZAMBIA
UGANDA
CAMEROON
NAMIBIA
KENYA
GHANA
SELECT YOUR COUNTRY AND PRICE
*
SOUTH AFRICA: R 3,000
GHANA: 1,200 CEDIS
CAMEROON: 90,500 FRANC
ZAMBIA: 3,400 KWACHA
UGANDA: 550,000 SHILLINGS
NAMIBIA: 3,500 NAD
KENYA: 15,000 KSH
YOUR ORDER MUST BE UNDER 5 DAYS, Kindly adjust it, if is over 5 days.
*
I am Ready To Receive My Parcel
Required
Submit
Clear form
Never submit passwords through Google Forms.
Forms
This content is neither created nor endorsed by Google.
Report Abuse
Terms of Service
Privacy Policy