"*" indicates required fields Step 1 of 2 50% For Internal Use OnlyCustomer Type* Individual Corporate SOF Generator*For Whatsapp/Walkin Customer, select Yes, no need to upload IC & Bank Card. Yes (WS/Walk In Customer) No (Online Customer) Order InformationPayment Method Rental Instalment Outright Total (RM) HiddenQuantity (Do Not Edit)*123456789Order Quantity*12345678910HiddenTotal Rental (RM)Order Information (Rental)Rental Product*VILLAEM 2AISKECILNEO PLUSGLAZEOMBAKINCEPTIONLUCY PLUSCORE PLUSHARRYFERRYCINNAMON== AIR PURIFIER ==LOMBOK 3STORMSTORM IICAPTAINNOBLEBREEZETUBA== OTHERS ==OUTDOOR FILTERBAMBOO PLUSLILYMANUAL BIDETBATERI BIDETRental Promotion*COWAY FIESTA== 🛍️ 50% OFF ==HEBAT 7 - NEO PLUS (50% Discount)WOW 7 - NEO PLUS (50% Discount)WOW 5 - NEO PLUS (50% Discount)WOW 5 - KECIL (50% Discount)WOW 7 - KECIL (50% Discount)WOW 5 - VILLAEM 2 (50% DISCOUNT)WOW 5 - CORE PLUS (50% Discount)WOW 5 - OMBAKWOW 5 - AIS (50% Discount)WOW 7 - AIS (50% Discount)WOW 7 - LUCY PLUS (50% Discount)WOW 5 - STORM II (50% DISCOUNT)WOW 5 - BREEZE (50% DISCOUNT)WOW 5 - LOMBOK 3 (50% DISCOUNT)WOW 5 - TUBA (50% DISCOUNT)WOW 5 - NOBLE (50% DISCOUNT)== 🥛 WOW WP ==HEBAT 7 - NEO PLUSWOW 7 - NEO PLUSWOW 5 - NEO PLUSWOW 5 - CORE PLUSWOW 5 - KECILWOW 7 - KECILWOW 5 - COREWOW 5 - AISWOW 7 - AISWOW 7 - LUCY PLUS== WOW CORPORATE ==WOW 5 - HARRYWOW 5 - CORE PLUSWOW 5 - VILLAEM 2== 🌪️ WOW AP ==COWAY FIESTA - STORM II (4 MTH SRV)WOW 5 - STORM II (2 MTH SRV)WOW 5 - STORM 2 (4 MTH SRV)WOW 5 - STORMWOW 7 - STORMWOW 5 - LOMBOK 3WOW 5 - NOBLEWOW 5 - TUBAWOW 5 - BATERI BIDETWOW 5 - BAMBOO PLUSWOW 7 - BAMBOO PLUS== COMBO & ICARE ==COMBOCOMBO SPECIALCOMBO NEO PLUSCOMBO BAMBOO PLUSCOWAY FIESTA FREE MINERAL FILTER X3== BAMBOO ==WOW 5 - OUTDOOR FILTERWOW 7 - OUTDOOR FILTERWOW 5 - OUTDOOR FILTER (50% DISCOUNT)WOW 5 - BAMBOO PLUSWOW 7 - BAMBOO PLUS + PV== JOM TUKAR ==JOM TUKARJOM TUKAR - NEO PLUS (7+0 4 MTH SRV) (50% DISCOUNT)JOM TUKAR - VILLAEM 2JOM TUKAR - CORE PLUSJOM TUKAR - OMBAKJOM TUKAR - INCEPTIONJOM TUKAR - LUCY PLUSJOM TUKAR - AISCombo Product+ STORM+ LOMBOK 3+ BAMBOO PLUSRental Obligation Period (Years)* 3+2 5+0 6+0 7+0 Special RemarksFor 2024 Super Crazy Promotion, please add (50% Discount) Order Information (Outright)Total Outright (RM)Outright Product*VILLAEM 2CORE PLUSNEO PLUSCINNAMONGLAZEOMBAKKECILINCEPTIONLUCYHARRYFERRYMATE== AIR PURIFIER ==LOMBOK 3STORMCAPTAINBREEZETUBA== OTHERS ==BAMBOOLILYFONTANAOutright Promotion*NO PROMOTION1+1 PROMOTIONJOMTUKAR PROMOTIONPREMIUM OUTRIGHT: FREE NEOFLAM SETPlease choose "NO PROMOTION" for Glaze, Kecil & Lombok 3.Generate MOTO IPP Form? Yes, Generate MOTO MOTO IPP FormHiddenDate* DD slash MM slash YYYY SOF Number* Cardholder Name* For debit card, please enter full name as per IC.Card Number (XXXX-XXXX-XXXX-XXXX)* Card Expiry Date (MMYY)* Bank Name* Installment Period* Card Type* Visa Master HP SignatureAgent ParticularsSOF Serial Number* Agent Name* Agent Code* Agent Email Customer ParticularsFull Name (As Per NRIC/SSM)* New IC/SSM Number* Date of Birth (DD/MM/YYYY)* Title / Gender* Mr / Male Mrs / Female Race* Malay Indian Chinese Others Installation Address (With City & State)*Postcode* Phone (Mobile)* Phone (Alt./Home)* Customer Email* Corporate DetailsBilling Address*Please mention "SAME AS ABOVE" if both address same.SAME AS ABOVEPhone (Office)* Billing/Finance Email* Billing Contact Name* Contact Name Designation* Directors Name & Designation* Card Authorization (Rental)NRIC/Passport (Front Copy)* Debit/Credit Card (Front Copy)* Cardholder Name* Bank Name* Card No* Expiry Card (MM/YY)* Monthly Rental Fee Customer Signature*Remarks CommentsThis field is for validation purposes and should be left unchanged.