Online Order  

If order by fax please print out the form HERE and fax to (604) 826 4188

Instruction
Please complete the following details below.

 Require *
Bill to :
Company Name
*Contact Person
*Address
*Postcode
*Country
Telephone (Home)
Telephone (Office)
Mobile Phone
Fax
E-Mail
Deliver to :
*Product Code example: V101.   pls refer Catalog
*Unit Price (Ringgit Malaysia)
*Recipient
*Address
Telephone
Mobile Phone
*Delivery Date (dd/mm/yyyy)
Delivery Time
Before 12.00noon
Before 5.00pm
Anytime
Message (if any)
From (Name)
*Total Amount (Ringgit Malaysia)
Payment Methods
Card Member Name
Card Number
Expiry Date
CVC(Security Number Behind Your Card)
 
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