PAYMENT METHOD

Enagic (Malaysia) Sdn Bhd No. 971103 (AJL931978)

CASH CHEQUE CHEQUE NO.: REMITTANCE MOTO
Tel: 03-2282-2332 Fax: 03-2282-2335 Web: www.enagic.com E-PAYMENT
Address: Unit 29-7, 7F, The Boulevard Mid Valley City, Lingkaran Syed Putra, 59200 Kuala Lumpur
DISTRIBUTOR ID CREDIT CARD (SINGLE PAYMENT)
FOR OFFICE USE ONLY VISA MASTER DEBIT OTHERS: (PLEASE STATE)
APPLICANT REGISTERING AS A: DISTRIBUTOR (PROVIDE IC COPY & BANK STATEMENT) INSTALLMENT PLAN: PLEASE YOUR CHOICE
MEMBER PURCHASE USER (NO NEED TO PROVIDE IC COPY & BANK STATEMENT) CREDIT CARD INSTALLMENT OTHERS
PRINCIPAL INFORMATION
NAME, COMPANY NAME 6 MONTHS 6 9 MONTHS
12 MONTHS 12 15 MONTHS
GENDER NRIC OR PASSPORT NO. OR COMPANY NO. 18 MONTHS 18 30 MONTHS
Male / / 24 MONTHS 24 36 MONTHS
Female DDMMYYYY 36 MONTHS
ADDRESS *PLEASE SUBMIT INSTALLMENT PLAN FORM TOGETHER WITH APPLICATION
UNIT PRICE: RM
CITY POSTAL CODE STATE FOR OFFICE USE ONLY
SHIPPING: RM RECEIVED BY:
PHONE NO.: HOME/OFFICE FAX MOBILE NO. REGISTRATION FEES: RM 50.00 (INCLUDED STARTER KIT)
APPLICATION DATE:
E-MAIL ADDRESS: TOTAL: RM
SPONSOR INFORMATION AGREEMENT
SPONSOR'S NAME SPONSOR'S ID NO. I CERTIFY THAT I HAVE BEEN FURNISHED A COPY OF AND HAVE READ, UNDERSTAND AND AGREE TO THE PROVISIONS IN ENAGIC
(MALAYSIA) SDN BHD, POLICIES & PROCEDURES HANDBOOK, WHICH DOCUMENTS (WITH ANY AMENDMENTS OR RESTATEMENTS
REGISTER THE APPLICANT AS YOUR ( ) A FURNISHED BY ENAGIC MALAYSIA TO ME AFTER THIS DATE), THE EXCLUSIVE TERMS AND CONDITIONS OF MY AGREEMENT WITH
PRODUCT ORDER ENAGIC (MALAYSIA) SDN BHD.
PRODUCT SERIAL NO. UNIT PRICE
SD501 RM 12,000 ENAGIC (MALAYSIA) SDN BHD HEREBY ACCEPTS THE APPLICATION OF THE INDIVIDUAL/COMPANY NAMED BELOW AS A USER OR
JRII ANESPA RM 6,800 DISTRIBUTOR OF ITS PRODUCTS IN ACCORDANCE WITH THE TERMS AND CONDITIONS IN THE ENAGIC (MALAYSIA) POLICIES &
SD501-PT RM 13,200 PROCEDURES HANDBOOK. THE USER OR DISTRIBUTOR REPRESENTS AND WARRANTS THAT HE/SHE IS OF LEGAL AGE, WHICH IS
ANESPA - MEMBER RM 4,760 EIGHTEEN (18) YEARS IN MALAYSIA, AND THAT ALL INFORMATION PROVIDED TO ENAGIC (MALAYSIA) IS COMPLETE & ACCURATE.
PICK-UP AT OFFICE BY APPLICANT ALTERNATE PICK-UP
DELIVERY (PLEASE SELECT COURIER COMPANY BELOW) UPON SIGNING THIS APPLICATION, A DISTRIBUTOR WILL HAVE THE RIGHT TO DISTRIBUTE ENAGIC (MALAYSIA) PRODUCTS
SHIPPING DETAILS (SHIPPING CHARGES BELOW ARE ONLY APPLICABLE FOR SD501, JRII, SD501-PT, ANESPA) WITHIN MALAYSIA AND TO ENJOY THE BENEFITS OF BEING A DISTRIBUTOR ON THE TERMS & CONDITIONS
AREA (PLEASE AREA & COURIER) DHL GD EX IN THE POLICIES AND PROCEDURES HANDBOOK.
KL, PENANG, MELAKA, JB, IPOH RM 180 RM 30
KUCHING RM 330 RM 130 I HEREBY CONFIRM THAT I AM SUBMITTING THIS APPLICATION AS A (PLEASE ): USER DISTRIBUTOR
KOTA KINABALU RM 330 RM 140 AFTER 72 HOURS, I AGREED TO RESCIND THE 10 DAYS COOLING OFF PERIOD.
SARAWAK, SABAH, LABUAN RM 330 RM 150 APPLICANT'S SIGNATURE DATE SPONSOR'S SIGNATURE DATE
CITIES NOT LISTED (PEN. MALAYSIA ONLY) NOT AVAILABLE RM 45
ADDRESS:
PLEASE AND ENSURE YOU SUBMIT THESE DOCUMENTS WITH YOUR APPLICATION.
APPLICATION FORM BANK STATEMENT IC COPY
RECEIVER: PHONE NO.: OTHER DOCUMENTS - EPP, DCr, AEON, ALTERNATE PAYER FORM, MACHINE PICK-UP AUTHORIZATION FORM ETC.
DATE OF BIRTH
Product Application Form
PUBLIC BANK AEON CIMB HONG LEONG EPP DCr