Electronic Services Requisition Form

Electronic Services Requisition Form
Customer Details
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Handphone Number*

Area CodePhone Number
Home Number

Area CodePhone Number
Electronic Services

Please select the require services
Electric Kettle*
Electric Pressure Cooker*
Additional Requests
- Requisition must be made at least 2 days before.
- 50% deposit is required for booking confirmation.
- Deposit will be NOT return if cancellation.
- The item MUST send to us.
* Price to be confirmed after checking the items.
Enter the message as it's shown*
Should be Empty:

Customer Details