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| Order Form via Post |
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| Send cheque /money order to ; |
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| Sharipah Nor Irma Dariah |
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| B-15-1,
Blok B, Jalan Teknologi 3/9, Bistari De Kota, Kota Damansara, 47810 Petaling
Jaya, Selangor |
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| Name : |
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| Address : |
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| Hp no: |
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E-mail: |
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| (Please make sure
all informations are correct to ensure you receive your order) |
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Size |
Quantity |
Price |
Total |
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Unit |
RM |
RM |
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| Total payment |
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| Cheque/money order no: |
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| Print this form,
fill up and post together with the cheque/money order to the above address |
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