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Order Form


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