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REQUEST FORM FOR HOUSE CALL

DATE____________________________

CONTACT PERSON___________________________________________________________________

CONTACT NUMBER__________________________________________________________________________

ADDRESS___________________________________________________________________________________

____________________________________________ PREFERRED TIME ______________________


(where the items are located)

How did you hear about our house call service? Please which
Internet Word of Mouth Classified Ads Cash Converters House Call Van Others

The House Call service we provide is free on the understanding that the items listed below are either as
described or in good working condition. Cash Converters reserves the right to impose a “House Call”
charge of S$50 (or currency equivalent) on the customer, if it is found that majority of the items are faulty.
In order to avoid any disappointment, please test the more valuable items before finalizing arrangements.

Requirement for Free House-Call service: Volume of products sold should fill up at least a 1 ton lorry.

No. Brand Model Description Qty Cust Price


Expectation
1.

2.

3.

4.

5.

6.

7.

8.

9.

10.
This list will be reviewed and a representative of our company will contact you as soon as possible to make further arrangements.
Please fill in all information as much as possible.

You can fax / email the completed form to :


In Malaysia : (60x) xxxxxxx / xx.xxxxx.xxxx@gmail.com / Tel : 0xx xxxxxxx

To email, please save this form and send as attachment.


Customer’s Additional Remarks/Instructions:

Handled By: ___________________ Housecall Completed Date: _________________

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