LOLLIPOWER CHOCOLATE ORDERING FORM
DATE OF DELIVERY
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FULL NAME
*
HANDPHONE NO
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Area Code
Phone Number
EMAIL
DELIVERY ADDRESS
TYPE OF PRODUCT 1 & Quantity
QUANTITY
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DELIVERY METHOD
own pick-up
Need Delivery
Please make payment to : Azlien Donna @ Wan Norhatinie (162357002864) - Maybank
PAYMENT METHOD
Maybank2u
Cash Deposit
Others Online Banking
Cash
AMOUNT (RM)
INFO OF PAYMENT
PROOF OF PAYMENT SLIP
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