After Payment Form

ONLINE SHOPPING @ ETOI AND KOZEK COLLECTIONS

RM1329 TAMAN REMBIA PERKASA
ALOR GAJAH, MELAKA, 78000
Malaysia

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Email: onlineshoppingwithetoi@gmail.com

Phone: 019 - 3173864 / 019 - 2653864

http://facebook.com/etoiNkozek

EmailMeForm

Please fill out the form below complete with a true and valid data only. Any false information is strictly prohibited. Your IP will be recorded for security purposes /
Sila isikan borang dibawah lengkap dengan data yang benar dan sah sahaja. Sebarang maklumat palsu adalah dilarang sama sekali. IP anda akan direkod untuk tujuan keselamatan.

• Name *
• Email *
• Payment made at : *
  MM / DD / YYYY HH : MM AM PM AM/PM
• Payment Method *
  - Bank (Online Transfer) Bank (Cash Deposit) Paypal Money Order Cheque Others
• Bank Name *
  Maybank

  CIMB

  BIMB - Bank Islam
• Reference No. *
• Payment Amount *
  
  

  Bayaran dalam nilai Ringgit Malaysia Sahaja
• Comment

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