Balloonconnection

＊Required
Your name＊
Your e-mail address＊

Repeat e-mail address
Your address
Your telephone number＊
 -  - 
Cellular phone
 -  - 
Fax number
 -  - 
Code number of the balloons you want?＊
How many you want?
Do you need extra helium gas?＊

For delivery to Hokkaido,kyusyu and Shikoku or if you want keep balloons longer extra helium gas for topping up is required.
Ｈｏｗ　ｔｏ　ｐａｙ＊
Delivery address
Delivery address (Zip code)
Delivery address telephone number
 -  - 
Delivery address contact/details(Hotel name,bride and grooms names)
Required day of delivery?＊
 Y  M  D 
For delibery to a wedding we require time and date of ceremony
 Y  M  D  TIME 
Your greeting/message to be sent with balloons＊