The Baby Chantek Shop Order Form

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Your Email:

A Password:

Name: *

First,MI(Optional),LastName

Address Line1: *

Street Address

Address Line2:

Street Address2 (optional)

City: *

State: *

Postal Code: *

Zip Code

Email Address: *

Email Address

Telephone Number: *

Home or Business Telephone Number

If your are giving away as a gift and need us to deliver it, please fill this section. (Otherwise, we will send it to your address above)

Name:

First,MI(Optional),LastName

Address Line1:

Street Address

Address Line2:

Street Address2 (optional)

City:

Postal Code:

Zip Code

State

Telephone Number:

Home or Business Telephone Number

Item(s)

Code Number *BC .....

Quantity * .....

Unit Price(RM) *RM .....

Total *RM

Add Item

____________________________________________________

Total *RM

Delivery Options

Total CostRM

Payment Options

Please Tick One *
Maybank account : 101302050141 --> (Tengku Hazmin Hanum)
CIMB account : 12320001549204 --> (Tengku Hazmin Hanum)

Remark(Inquiries @ Transaction Proof)

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