ENAGIC (MALAYSIA) SDN BHD No.

971103-W (AJL931978)
Unit 29-7, 7F, The Boulevard Mid Valley City Lingkaran Syed Putra 59200 K.L
Tel: 03-2282 2332
Fax: 03-2282 2335
Web: www.enagic.com

MAIL ORDER FORM

(Only Applicable For SD501, JRII, SD501-PT, Anespa)

Name as in I.C / Passport

NRIC Number

Address

Postcode

City

Mobile Number

Product Purchased:

Email Address

Unit Price:

Credit Card Payment Facilities (For Single Payment Only)

1. Credit Card Number
2. Credit Card Type (Visa/ Master)
(Month / Year)
3. Credit Card Expiry Date
4. CVV number
Last 3 digit number on Credit Card
TERMS AND CONDITIONS
ORDERING:
1. Copy of credit card with clearly image (Front & Back, must have CVV number and Signature) must be submitted.
2. Application form(s) must be fully completed and fax, email or mail to the company, incomplete order form(s) will not be processed.
Product application form, Distributor/ User Agreement, Bank Statement, Mail Order Form, Copy of Credit Card & NRIC etc must be submitted.

3. In order to avoid duplication, please do not mail or email in the original order form if the order is placed by fax.
4. The application process takes three to four (3-4) working days.
5. Once the order is placed, no change can be made.
6. Only Applicable For SD501, JRII, SD501-PT, Anespa
METHOD OF PAYMENT:
1. Only for VISA and MASTERCARD local bank credit card.
2. DEBIT and AMEX are not entitled.
SHIPPING OF ORDER:
1. Shipping fees cannot be included with this payment method. Kindly pay the shipping fees separately by cash, TT or cheque.
The MOTO Payment provided by indidual bank is subject to indidual bank's terms and conditions. By signing on this form cardmembers
hereby agrees and understood all the terms and conditions imposed or stipulated by the individual bank and Enagic (Malaysia) Sdn Bhd.
All other Terms and Conditions shall apply. I agree to the above charges & fully aware for the payment done to Enagic (Malaysia) Sdn Bhd.

Cardmember's Signature

X
(As per the signature on the credit card)
Name:
Date: