CHANGE MODE OF PAYMENT
coway use only
Customer Name :
*
NRIC NO / Company NO / Business Registration NO :
*
Date Today:
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date today
BNK NAME :
*
NO KD :
*
NO KD BELAKANG 4 DIGIT :
*
last no card 4 digit
Signature :
*
Contact No Customer :
*
Order No Customer :
*
Attachment Gambar IC & KD seperti contoh diatas:
*
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