JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
"Phoenix" Fountain Pen for the Revival of Wajima Support and Order Form
To purchase and support, please fill out the form below and submit.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Project Proposal Document
Please select the type of purchase or support.
*
Special Premium 10,000 USD （The design will be announced at a later date)
Premium 2,500 USD
Standard 1,200 USD
Only donate without ordering a fountain pen
If you choose to donate only in the section above, please enter the amount in USD.
Your answer
Premium Design
Standard Design
Standard design
Your first name
*
Your answer
Your last name
*
Your answer
Phone number
Your answer
E-Mail Address
*
Your answer
Country
*
Your answer
Address
*
Your answer
Payment Methods ※
Considering the purpose of the support, we kindly request payment in advance.
*
PayPal
Bank transfer
Inquiry
Your answer
Your support and purchase will surely contribute to the revival of Wajima's urushi lacquer industry, much like the phoenix rising from the ashes.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of 松沢漆工房.
Report Abuse
Forms
