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Bank In Notification Form
This form is only for user who has made the payment for their order. Please do not submit this form if you have not make the payment.

Please fill up all the fields and click on "Notify Us" button to notify us about your payment.
(* indicates compulsory fields)
Name / Username
*
:
Phone Number
*
:
Email Address :

Paid To
*
:
Bill Number
*
:
Paid Amount(RM)
*
:
Payment Date :
Reference Number :
Message :
Verification Code
*
: Image verification



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*Notes: Please fill in the information as much as you can in order for us easy to follow up your order.
We would really appreciate for your cooperate.