Application Form (Individual)
We are the authorized reseller that can help you to handle your application from the beginning to the end.
Name as per NRIC
NRIC Number
Contact Number
Installation Address
Emergency Contact Person
Contact Number
Relationship
E-mail
Choose Your Preferred Products
Please Select
Penapis Air Cuckoo EPIC [Rental RM72.08/Outright RM2,438]
Penapis Air Cuckoo JAZZ [Rental RM160.00/Outright RM4,999
Penapis Air Cuckoo FUSION TOP [Rental RM103.88/Outright RM3,392]
Penapis Air Cuckoo FUSION STAND [Rental RM121.90/Outright RM4,028]
Penapis Air Cuckoo ICON [Rental RM120.00/Outright RM4,452]
Penapis Air Cuckoo GRACE [Outright RM3,604]
Penapis Air Cuckoo DELUXE [Rental RM130.00/Outright RM4,500]
Penapis Udara Cuckoo B MODEL [Rental RM120.00/Outright RM2,988]
Multi-Cooker Cuckoo BLACK HN 10 [Outright RM2,650]
Multi-Cooker Cuckoo RED M10 [Rental RM50.00/Outright RM1,500]
Choose Your Purchase Method
Monthly Rental
Outright
Choose Your Preferred Monthly Payment Option
Auto Debit Bank Account
Auto Debit Credit Card
Bank Name
NRIC Front Page
Upload a File
Cancel
of
Credit Card/Front Page Account Book (or online)
Upload a File
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of
Direct Debit/Auto Debit Form
Upload a File
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of
PreSales Agreement
Upload a File
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of
Account Number
Signature
Submit
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