Coway Homecare Sales Order Form (HSOF)

MSO Reference No.

MSO*

MSO Reference No. (TnC)

Customer Signature/Date (T&C Page2)

MSO Reference No. (TnC2)

Customer Type*

IndividualCorporate

CUSTOMER PARTICULARS

Title*

Full Name as per I/C or Company Name*

NRIC (New) / Passport / Company No.*

NRIC (Old) / Police ID Army ID (if any)

Installation Address (Malaysia Only)*

Address ( Max 70 letters including space)0/70

*

Address 2 ( Max 35 letters including space)

State*

Postcode*

5 digits only

Tel (Mobile) (1)*

Tel (Residence)*

Tel (Office) (1)

Ext.

E-mail (1)*

example@example.com

Other Customer Particulars (Applicable to Individual only)

Date of Birth

Date

Race*

Gender

MaleFemale

Monthly Billing Method

Rows	Mobile (1) / E-Mail 1	Mobile (2) / E-Mail 2
Default SMS send to
Default E-mail to

Additional Service Contact Person Information (Applicable to both Individual and Corporate)

Contact same as above (copy)

Yes

Second Contact Person

Tel (Mobile) (2)

Tel (Office) (2)

Ext.

Corporate Customer Billing Information

Note: Other than Government and bank, E-Invoice feature will be enrolled automatically. Please e-mail to billing@coway.com.my for any change of monthly invoice delivery mode.

Contact same as above (copy)

Yes

(S/B & SME) only

Do not group billing with previous order(s) (S/B & SME) only

Billing Contact Person

Billing Address

Address

Address Line 2 (City, State)

Postcode

Tel (Office)

Ext.

Department

Monthly Billing Method*

Rows	E-Mail (1)	E-Mail (2) or URL	Tick
E-mail invoice to
Paper Invoice (Application to Government agencies & banks only)
Upload via Vendor / Supplier's Portal Web Address (URL)

Tax Identification Number (TIN)

11 to 14 alphanumeric

SST Number

For Customer who have 2 sets of SST (Sales Tax No & Service Tax No registered separately), the way to key in will come with comma “ ; ” & no space

Order & Payment Information

Product Model*

Model Name*

Mattress Size*

KingQueen

Air Conditioner Size*

1.0HP1.5HP2.0HP

Air Conditioner Type*

F SeriesP Series

Air Conditioner Colour*

WhiteBlack

Mattress Type (For Prime & Prime II Series only)

FirmSoft

Massage Bed Type

StandardPremium

Massage Chair Colour

Blue

Pebble Colour

BlueGreyPinkBeige

Mine Colour

BlackBeigeBrown

Massage Bed Colour

BlackBeige (Applicable for Premium only)

Mattress Package*

Mattress ONLYMattress & *Bedframe (SET)

Mattress & *Bedframe (SET) *Applicable for Prime II only*

FabricLeather

Quantity*

Mattress Order*

Rows	King	Queen	Firm	Soft	Quantity
1) Prime Series Mattress ONLY

Order Application Type*

OutrightInstalmentRental

Rental Period (years)*

Total Rental Processing Fee (RPF)

Total Monthly Rental Fee

Total Price (Outright/Instalment)

Outright/Instalment

Rental

Auto / Direct DebitAdvance 1 / 2 yearsE-PortalRegular (Company Only)

I hereby authorise Coway (Malaysia) Sdn. Bhd. (“Coway”) to charge my debit / credit card for the following sums: Rental Processing Fee (“RPF”) - (One-time charge upon signing of this Agreement) and Monthly Rental Fee - (Monthly deductions until termination or expiry of this Agreement)

Total Rental Processing Fee (RPF)

RM

Total Monthly Rental Fee

RM

Card No. (First 6 digits)

Card No. (Last 4 digits)

Card Holder Name

Signature & Stamp

Third Party Payee Payment?

Yes

I/We (Third Party Name - NRIC/Co. No.) hereby authorise payments for this Order to be charged to / deducted from my credit card / debit card / savings account, as the third party payee.

Third Party Name

NRIC No. / Company. No.

Credit Card/Debit Card/Direct Debit

A copy of IC/SSM and Credit/Debit Card/Bank Statement submitted.A copy of Direct Debit Form for charging my savings account submitted

Savings account no.

Issuing Bank

Signature & Stamp

Promotion Code Special Instruction:*

Non-Product Return

Yes, return the old productNo, keep the old product (Applies only for Air Purifies, Mattress and Massage Chair)

Previous Order No.:

Preferred Installation Date

Date

I/We unequivocally and voluntarily wish to waive my/our statutory cooling-off rights; and have the Product Installed immediately upon the expiry of 72 hours hereof.*

AgreeDisagree

I/We declare that:

(I) the particulars stated above are true and correct;

(II) I/We have read and agree to be bound by the Terms and Conditions set out herein and on the reverse side of this Forms;

(III) I/We the undersigned hereby give my/our consent to CTOS Data System Sdn Bhd, Coway's appointed credit reporting agency to disclose my/our credit information to Coway for the purposes of determining my/our credit standing;

(IV) I/We have read Coway's Privacy Notice at https://www.coway.com.my/privacy-notice and consent to the collection and processing of my/our personal information by Coway in accordance with Coway Privacy Notice;

(V) I/We have obtained the prior consent of the Second Contact Person stated above for the cancellation and processing of my/our personal information by Coway in accordance with Coway's Privacy Notice;

*I/we agree to receive marketing and promotional information about products/services offered by Coway and/or which Coway believes may be of interest to me/us ("Marketing Messages") by any modes of communication.

*You have the right to opt out of receiving Marketing Messages by (i) clicking on the "unsubscribe" link provided in each email/SMS you might receive; or (ii) by contacting our Toll-Free Careline at 1800-888-111.

Customer Signature/Date (Front Page)

Customer Signature/Date (T&C Page)

Sales Person Name

Sales Person Code

TR No.

Mobile No.

RM

Order No.

Card Auto Debit Authorisation

Third-Party Payee Payment Authorisation (if any)

THIS CONTRACT IS SUBJECT TO A TEN WORKING DAYS COOLING-OFF PERIOD

Internal Use