Order Form

ORDER FORM
TYPE OF CUSTOMER: New customer
Existing customer
FULL NAME (as per I/C):
E-MAIL:
CONTACT NO:
DELIVERY ADDRESS:

ORDER DESCRIPTIONS:
1)Code:
2)Item type:
3)Quantity (pcs):
4)Remark (if any):
DELIVERY VIA: PosLaju
Pos Register
Pos Express (not recommended-customer bear the risk)
PAYMENT TYPE: Cash Deposit Machine (CDM*Bank-in)
Transfer Fund (Internet Banking)
EXPECTED PAYMENT DATE (dd/mm/yy):

IF PAYMENT MADE BEFORE ORDERING FORM:
1)Payment Center(Bank)/Location:
2)ATM SEQ NO.(Transaction/Receipt no.):
3)Amount RM:

*** PAYMENT MUST BE DONE WITHIN 24 HOURS AFTER FORM SUBMISSION ***

#### We seek your co-operation to inform us immediately after payment done via Calls, E-mail or Instant Message (YM) A.S.A.P. ####

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