ORDER FORM

Name:
ADDRESS :
PHONE NUMBER :
EMAIL :
TYPES OF CONCT LENS :
CONCTACT LENS DEGREE (0 - 1000)
AGREE WITH OUR TERM & CONDITION :	YES NO
DELIVERY METHOD VIA :	POS EKSPRESS POS LAJU
TRANSFERATION~~	TRANSFER BY MBB TRANSFER BY CIMB TRANSFER BY BNK ISLAM BANKIN @ ATM MECHINE

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