Retail Order Form

Referred by:

AgentCustomerUrbanGrow PersonnelOther

Agent Code

Customer Name

UrbanGrow Personnel Name

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 Bundles

Baby Spinach x 1 Butterhead x 1 Roasted Saseme Sauce x 1 Sesame Soy Sauce x 1

13.00MYR Quantity

Curly Kale

10.50MYR Quantity

Purple Kale

11.50MYR Quantity

Swiss Chard

11.50MYR Quantity

Baby Spinach

9.20MYR Quantity

Batavia

Batavia Babyleaf

6.00MYR Quantity

Green Coral

Green Coral Lettuce

6.50MYR Quantity

Butterhead

Butterhead Lettuce

5.50MYR Quantity

Red Coral

9.00MYR Quantity

Mix Coral

Mix Coral Lettuce

8.00MYR Quantity

Romaine

Romaine Lettuce

5.80MYR Quantity

Crispinet

Crispy Lettuce

6.40MYR Quantity

Easy Green

Easy Green Lettuce

6.40MYR Quantity

Easy Red

Easy Red Lettuce

8.00MYR Quantity

Green Oak

6.40MYR Quantity

Red Oak

8.60MYR Quantity

Ezfrill

Easy Frill

8.00MYR Quantity

Thai Sweet Basil (50g pack)

Authentic Thai Basil

5.60MYR Quantity

Italian Sweet Basil (50g pack)

Italian Sweet Basil

5.60MYR Quantity

Opal Basil (50g pack)

Dark Opal Basil

5.60MYR Quantity

Rocket (50g pack)

4.90MYR Quantity

Wild Rocket (50g pack)

6.70MYR Quantity

Dill (10g pack)

3.00MYR Quantity

Thyme (10g pack)

3.00MYR Quantity

Oregano (10g pack)

3.00MYR Quantity

Corriander (10g pack)

3.00MYR Quantity

Italian Parsley (10g pack)

3.00MYR Quantity

Bak Choy

Pak Choy

4.70MYR Quantity

Baby COS

5.80MYR Quantity

Gift Basket - Mix Varieties

Mix Varieties of Fresh Vegetables comes in a basket

60.00MYR Quantity

Italian Mix Salad

Baby Spinach, Butterhead, Red Oak, Batavia and Arugula

7.80MYR Quantity

Delivery

Please 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)

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.

Special Requests:

We will try our best to accommodate your requests. Thank you very much.

Retail Order Form

Customer Details

Delivery Charges