Order Form

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	Customer Information
	Receiver Name (English)* First Name Last Name
	Email Address* eg. email@gmail.com
	Contact No.*
	Receiver Address* City State/Province Zip/Postal

	Order List
	Sony VAIO 14 inch VAIO E Series (Pink) 14 inch VAIO E Series (White)
	Toshiba Toshiba TECRA R840-2003X Toshiba TECRA R840-2009X Toshiba TOSHIBA L745-1138X Toshiba P745-1011X
	Asus Asus A43SA-VX084 Asus A43SA-VX083V Asus K53-1BSX

	Payment Method
	Bank Account No. Name Remark 50215679437907 BKAS1013 GROUP G1 Current Account 02068790436798 BKAS1013 GROUP G1 488785688 BKAS1013 GROUP G1 004356895433 BKAS1013 GROUP G1 178690056748944 BKAS1013 GROUP G1 345894332680 BKAS1013 GROUP G1

	Payment Notification
	Payment Date* Day   01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   January February March April May June July August September October November December   2011
	Payer Bank* eg. CIMB
	Payee Bank* eg. CIMB
	Reference No.* (Key in "CDM" if you are using cash deposit machine)
	Bank In Amount*

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