COLLAR PIN ORDER FORM
Please complete this form if you would like to collect or have your new collar pin sent to you. Each member is entitled to ONE complimentary collar pin. You may purchase extra collar pins at a cost of RM12 per piece
Full Name:
*
In block letters, as per Identity Card/ Passport
Membership No.:
*
Mobile No:
*
e.g. 012-xxxxxxx
MICPA Product
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Collar Pin
Free
MYR
Quantity
1
Extra Collar Pin
12.00
MYR
Quantity
0
1
2
3
4
5
6
7
8
9
10
Shipping Charges (Peninsular Area)
10.00
MYR
Shipping Charges (Sabah/ Sarawak)
15.00
MYR
DELIVERY OPTIONS (please choose one):
Option 1: Personally collect at MICPA office (from 8.30 am – 5.30 pm. Monday to Friday). Please advise on the date and time you want to come and collect.
Option 2: If you would like to send a representative to collect on behalf, please provide his/her name
Option 3: Shipping Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PAYMENT METHODS
Please refer to rate of fees payable and tick your preferred payment method:
*
Cash at MICPA's office
Online Banking (CIMB Bank Account No: 8001554071 Account Name: MICPA Swiftcode CIBBMYKL). Please upload your transaction slip below
Cheque - made payable in RM to "THE MALAYSIAN INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS" or "MICPA". (For outstation cheques, please include RM0.50 bank charges)
Credit Card - option to pay at MICPA's office or by providing your credit card details below
Credit Card details
Details
Credit card number
Expiry Date
Issuing Bank
Cardholder's Name
Signature as per credit card
Please upload the payment transfer slip
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