Coway Sales Order Form (SOF) - Version 3

SOF Reference No.
SOF*
SOF*
SOF Reference No (T&C)
SOF Reference No (T&C)2
Customer Type*

IndividualCorporate
CUSTOMER PARTICULARS
Title*

Tan Sri.Dato.Datin.Dr.Mr.Mrs.Ms.
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)
Installation Address (Malaysia Only)

Address ( Max 70 characters including space)

Address 2 (Max 40 characters including space)

City, StateState / Province

Postal / Zip Code
State*
Postcode*
5 digits only
Tel (Mobile) (1)*
Tel (Residence) (1)*
Tel (Office) (1)
Ext
E mail (1)
example@example.com
Other Customer Particulars (Applicable to Individual only)
Date of Birth*

DayMonthYear
Date
Race

MalayChineseIndianKoreanOther
Gender

MaleFemale

Monthly Billing Method

	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)
Billing Contact Person
Billing Address

Address

Address Line 2 (City, State)

CityState / Province

Postal / Zip Code
Postcode
5 digits only
Tel (Office)
Ext
Department

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
Combo

YesNo
Product Model 1*
Product Model 2*
Quantity*
Order Application Type*

RentalOutrightInstalment
Service Type*

Self-ServiceHeart Service
Service Type - Heart Service*

2M4M6M
Rental Period*

3+25+06+07+0Other
Filter Option (Applicable only for Storm II and Lombok III under Heart Service)

Fine DustAllergenPetKitchenSmoke (For Noble 2 only)Fresh Home (For Noble 2 only)
Total Rental Processing Fee
Total Monthly Rental Fee
Total Price (Outright/Instalment)
Outright/Instalment

CashChequeCredit Card/Debit Card6M12M18M24M36M
Rental

Auto / Direct DebitAdvance 1 / 2 YearsE-PortalRegular (Company Only)
Card Auto Debit Authorisation
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
Total Monthly Rental Fee
Card No. (First 6 digits)
Card No. (Last 4 digits)
Card Holder Name
Signature

Clear
Third Party Payee Payment?

Yes
Third-Party Payee Payment Authorisation
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 a 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

Clear
Promotion Code Special Instruction:*
Old Product Return

Yes, return the old productNo, keep the old product (*Only applicable for Air Purifier, Mattress & Massage Chair)
Previous Order No.:
THIS CONTRACT IS SUBJECT TO A TEN WORKING DAYS COOLING-OFF
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 Form;

(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’s Privacy Notice;

(V) I/we have obtained the prior consent of the Second Contact Person stated above for the collection and processing of his/her 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 ( clicking on the " link provided in each email/SMS you might receive or ( by contacting our Toll Free Careline at 1800 888 111
Customer Signature/Date (Front Page)

Clear
Customer Signature/Date (Terms & Conditions Page)

Clear
Customer Signature/Date (Terms & Conditions Page)

Clear
Internal Use
Sales Person Name
Sales Person Code
Mobile No.
TR No.
RM
Order No.
Date

MonthDayYear
Date
Should be Empty:

	E-Mail (1)	E-Mail (2) or URL
E-mail invoice to
Paper Invoice (Only applicable to Government/Bank)
Upload via Vendor / Supplier Portal Web Address URL

Card Auto Debit Authorisation

Third-Party Payee Payment Authorisation

Internal Use