Product Order Form
BeautyCare House-Cellglo五宝零售批发
Customer Information
顾客资料
Customer Name 顾客名字
*
First Name
Last Name
Phone Number电话号码
*
-
011
2345678
Email Address 邮件箱
*
Exp: abcdefg@gmail.com
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Shipping Address 邮寄地址
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Order list 订购商品
*
Example: Cellglo Crystal Eye x1
Our Bank Detail 我们的银行资料
*
Maybank (Chong Li Min) 154062733559
Hong Leong Bank (Chong Li Min) 17250157380
Bank Simpanan Nasional (Chong Li Min) 0413229000116214
Public Bank Berhad (Chong Li Min) 6453359127
Purchase Date 付款日期
*
-
Month
-
Day
Year
Exp：3/30/2018
Purchase Time 付款时间
*
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:
Hour小时
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Min分钟
AM
PM
AM/PM Option
Purchase Amount 付款金额
*
Exp：RM299
Upload Bank In Slip 上传汇款单据
*
Note备注
When you need us to notice something, then you are required to fill in the blank. （如果有才填）
Enter the message as it's shown 请输入以下字母数字
*
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