6 GHHS * To make It convenient for you, we have prepared few methods of payment for HEALTHCARE so.) 0.choose from. Kindly fax the completed form to +603-8945 3320 CREDIT CARD [Fo 1 Membership No. Healthcare Membership Programme - Rejoining Fee for year to my credit cord, Credit Card visa MASTER Others Card Issuing Bank Card Holder's Name Name on Card Card No. 7 ~ ~ 3 digit security no. (Computory) Expity date (MM/YY) 7 Contact No. ‘Amount Signature Date | eT Sez Va ome e ee For poyments by drect bankin, kindly enclose your bank:in sip together with this Payment Form and fax to 603-8945 3320 o: prove ot payment. sank etait: ot folows: issue fo Bonk “Account NO RHB BANK BERHAD 721218900024878 MALAYAN BANKING BERHAD (MBB) | 12747026358 Lea NOS ai Interest FREE Easy Payment Scheme is available with a minimum payment of RM 1,000 and above from various banks. Callus at 603-8955 8067 (Mr. Mustagin) tor more intmation, Ura) You may also choose to make payment directly at our office, * Country Heights Health Tourism Sdn Bhd LG-01, East Wing, Palace of the Golden Horses, Jalan Kuda Emas, Mines Wellness City, 43300 Seri Kembangan, Selangor Darul Ehsan. COUNTRY HEIGHTS HEALTH TOURISM SON BHD