Alias
On (Facebook/Instagrm / Twitter)
ex : Suraya Salleh (fb)
|
|
Name
ex : Nur Suraya
|
|
| Contact Number:
|
|
| Email:
|
|
| Payment Method (from your account):
|
|
| Payment Made (to our account):
|
CIMB BANK
MAYBANK |
Payment Details (fill in if payment already made)
**Amount (balance)
**Date / Time / Reference Number
ex : RM99 (1)
7/8/2010
(10:12:34)
ref : 12456867899
|
|
Detail Items:
ex : MAIRA - Tiffany Blue
|
|
| Shipping Method:
|
|
Collection Point:
**Leave it blank via post
|
|
Address:
**Leave it (-) via COD
|
|
|
|
