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  Customer Information
  

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  Full Name*
  
  
  
  
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  E-mail*
  
  
  
  ex: abc@example.com
  
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  Mobile No.*
  
  
  
  ex: 012-3456789
  
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  Address*
  
  
  
  
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  Order Information
  

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  Payment Made*
  
  
  
  Within 24 hours
  Within 48 hours
  Immediately
  
  
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  Preferred Bank*
  
  
  Maybank CIMB Cash on Delivery (for Shah Alam and Klang area only)
  
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  Delivery Method*
  
  
  Pos Laju Cash on Delivery (for Shah Alam and Klang area only)
  
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  Product Code*
  
  
  
  For order more than 1, please write like this. i.e SA201 (1), SA006 (2)
  
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  2nd Choice
  
  
  
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