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Purchase Order No.
Purchase Order Date
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NRIC
** NRIC not need to key in - or space **
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JOHOR
KEDAH
KELANTAN
MELAKA
NEGERI SEMBILAN
OTHER
PAHANG
PERAK
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No of Lot
Buy 1 lot = RM1,398.00
Buy 3 lots = RM4,194.00
Payment Method
Credit Card/Debit Card/Bank Transfer