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E-mail (2) :
Note: Other than for Government agencies and banks, the e-invoice feature will be enrolled automatically.
Order & Payment Information
(i) Product Model (ii) Quantity (iii) Outright (iv) Rental Period (years) : (v) Price : RM__________ (viii) Outright/Instalment
(a) Minimum Rental Period + Cash Cheque Credit / Debit Card
Core Plus Instalment (b) Extended Period : (vi) RPF 0
: RM__________ 6M 12M 18M 24M 36M
3+2 6+0 (ix) Rental
1 123
(vii) Monthly
Rental 5+0 7+0 Auto / Direct Debit Advance 1 / 2 years
Rental Fee : RM__________
Others (Please State: _________ ) E-Portal Regular (Company Only)
Credit Card / Debit Card Auto Debit Authorisation Signature
I hereby authorise Coway (Malaysia) Sdn. Bhd. ("Coway") to charge my debit / credit card for the following sums:
0
Rental Processing Fee ("RPF") - RM_______________________________ (One-time charge upon signing of this Agreement)
123
Monthly Rental Fee - RM_____________________________ (Monthly deductions until termination or expiry of this Agreement)
4283322086915616
Card No.: ___________________________________________________ Maybank
Issuing Bank: __________________________________________
HASLINA BINTI ABDUL KADIR
Card Holder Name: ________________________________________________________________ Expiry Month (MM/YY) : 03 / 26 Signed at:
2023-11-08 22:33:20
Third-Party Payee Payment Authorisation Signature & Stamp
I/We ______________________________________NRIC / Co.No.______________________________ hereby authorise payments for this Order to be
charged to/deducted from my credit card/debit card/savings account, as a third party payee.
A copy of NRIC/SSM and Credit/Debit Card/Bank Statement submitted. A copy of Direct Debit Form for charging my savings account submitted.
Savings account no.: ____________________________________________ Issuing Bank : __________________________________________________ D D / M M / Y Y
*I/we agree to receive marketing and promotional information about products/services offered by Coway and/or which Coway believes may be of interest to me/us (“Marketing Messages”) by any
modes of communication.
*You have the right to opt out of receiving Marketing Messages by (i) clicking on the "unsubscribe" link provided in each email/SMS you might receive; or (ii) by contacting our Toll-Free Careline at 1800-888-111.
__________________________________________________________________________________________________________________________________________________
Signed at: Customer Signature / Date
2023-11-08 22:33:20
Coway Sales Person Use Only
Sales Person Name NORASHIKIN BINTI ZULKAPLI
: _______________________________________________________ TR No. : _____________________________________________________
AAA HP597190_0136
E. This Agreement shall be governed by the laws of Malaysia.
Signed at:
2023-11-08 22:33:20