Retail Order Form

Referred by:

Other

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

13.00 MYR Quantity

Curly Kale

10.50 MYR Quantity

Purple Kale

11.50 MYR Quantity

Swiss Chard

11.50 MYR Quantity

Baby Spinach

9.20 MYR Quantity

Batavia

Batavia Babyleaf

6.00 MYR Quantity

Green Coral

Green Coral Lettuce

6.50 MYR Quantity

Butterhead

Butterhead Lettuce

5.50 MYR Quantity

Red Coral

9.00 MYR Quantity

Mix Coral

Mix Coral Lettuce

8.00 MYR Quantity

Romaine

Romaine Lettuce

5.80 MYR Quantity

Crispinet

Crispy Lettuce

6.40 MYR Quantity

Easy Green

Easy Green Lettuce

6.40 MYR Quantity

Easy Red

Easy Red Lettuce

8.00 MYR Quantity

Green Oak

6.40 MYR Quantity

Red Oak

8.60 MYR Quantity

Ezfrill

Easy Frill

8.00 MYR Quantity

Thai Sweet Basil (50g pack)

Authentic Thai Basil

5.60 MYR Quantity

Italian Sweet Basil (50g pack)

Italian Sweet Basil

5.60 MYR Quantity

Opal Basil (50g pack)

Dark Opal Basil

5.60 MYR Quantity

Rocket (50g pack)

4.90 MYR Quantity

Wild Rocket (50g pack)

6.70 MYR Quantity

Dill (10g pack)

3.00 MYR Quantity

Thyme (10g pack)

3.00 MYR Quantity

Oregano (10g pack)

3.00 MYR Quantity

Corriander (10g pack)

3.00 MYR Quantity

Italian Parsley (10g pack)

3.00 MYR Quantity

Bak Choy

Pak Choy

4.70 MYR Quantity

Baby COS

5.80 MYR Quantity

Gift Basket - Mix Varieties

Mix Varieties of Fresh Vegetables comes in a basket

60.00 MYR Quantity

Italian Mix Salad

Baby Spinach, Butterhead, Red Oak, Batavia and Arugula

7.80 MYR Quantity

Delivery

Please refer Zone description below for selection of delivery charges.

Free Zone

Enter coupon

Total

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 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

My Products

Delivery Charges