Retail Order Form

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AgentCustomerUrbanGrow PersonnelOther
Agent Code
Customer Name
UrbanGrow Personnel Name
Retail Order Form
Customer Details
Name*

First NameLast Name
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*

Area CodePhone Number

My Products

Quarterly Product BundlesBaby Spinach x 1 Butterhead x 1 Roasted Saseme Sauce x 1 Sesame Soy Sauce x 1

13.00MYR Quantity

Curly KaleCurly Kale

10.50MYR Quantity

Purple KalePurple Kale

11.50MYR Quantity

Swiss ChardSwiss Chard

11.50MYR Quantity

Baby SpinachBaby Spinach

9.20MYR Quantity

BataviaBatavia Babyleaf

6.00MYR Quantity

Green CoralGreen Coral Lettuce

6.50MYR Quantity

ButterheadButterhead Lettuce

5.50MYR Quantity

Red CoralRed Coral

9.00MYR Quantity

Mix CoralMix Coral Lettuce

8.00MYR Quantity

RomaineRomaine Lettuce

5.80MYR Quantity

CrispinetCrispy Lettuce

6.40MYR Quantity

Easy GreenEasy Green Lettuce

6.40MYR Quantity

Easy RedEasy Red Lettuce

8.00MYR Quantity

Green OakGreen Oak

6.40MYR Quantity

Red OakRed Oak

8.60MYR Quantity

EzfrillEasy Frill

8.00MYR Quantity

Thai Sweet Basil (50g pack) Product Image

Thai Sweet Basil (50g pack)Authentic Thai Basil

5.60MYR Quantity

Italian Sweet Basil (50g pack) Product Image

Italian Sweet Basil (50g pack)Italian Sweet Basil

5.60MYR Quantity

Opal Basil (50g pack)Dark Opal Basil

5.60MYR Quantity

Rocket (50g pack)Rocket (50g pack)

4.90MYR Quantity

Wild Rocket (50g pack)Wild Rocket (50g pack)

6.70MYR Quantity

Dill (10g pack)Dill (10g pack)

3.00MYR Quantity

Thyme (10g pack)Thyme (10g pack)

3.00MYR Quantity

Oregano (10g pack)Oregano (10g pack)

3.00MYR Quantity

Corriander (10g pack)Corriander (10g pack)

3.00MYR Quantity

Italian Parsley (10g pack) Product Image

Italian Parsley (10g pack)Italian Parsley (10g pack)

3.00MYR Quantity

Bak ChoyPak Choy

4.70MYR Quantity

Baby COSBaby COS

5.80MYR Quantity

Gift Basket - Mix Varieties Product Image

Gift Basket - Mix VarietiesMix Varieties of Fresh Vegetables comes in a basket

60.00MYR Quantity

Italian Mix SaladBaby Spinach, Butterhead, Red Oak, Batavia and Arugula

7.80MYR Quantity

DeliveryPlease refer Zone description below for selection of delivery charges.

FreeMYR Zone

Enter coupon

Total

0.00MYR

Please select Self Pick-up or Delivery according to your postcode list below. Please note that the delivery charges will not be added automatically to your total bill. Our agent will contact you for delivery charges payment.*

Self Pick-up (FREE)Zone 1 (RM10 or FREE for over RM50)Zone 2 (RM20 or RM10 for over RM50)Zone 3 (RM30 or RM20 for over RM50)
Self Pickup or Delivery Date (please give minimum 2 working days notice for pickup or delivery date)

DayMonthYear
Date
Self-Pickup Date & Time:

Mon - Fri (10:30am - 6:00pm), Sat (10:30am - 3:00pm) Closed on Sundays & on Public Holidays. Please give minimum 2 working days’ notice for self-pickup.

Delivery Date & Time:

Tuesdays & Fridays (11:00am – 6:00pm). Unavailable on Public Holidays. Please give minimum 2 working days’ notice for delivery.

Delivery Coverage Areas:

KL city, Bangsar, Damansara Heights, Bukit Tunku, Hartamas, Mont Kiara, TTDI, Desa Park, 1Utama, Ampang, Taman Seputeh, Sri Petaling, Old Klang Road, Bukit Jalil, Petaling Jaya, Subang Jaya

Note: Please do contact us if your delivery area is not listed above.
Delivery Charges

Please note that a delivery charge of RM10.00 will be imposed for order below RM50.00
Special Requests:
We will try our best to accommodate your requests. Thank you very much.
Should be Empty:

Retail Order Form

Customer Details

Delivery Charges