Name 姓名
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Email Address:
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Facebook Email Address (we will send ur order detail to ur fb inbox)
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Contact Number 联络号码
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Address 地址
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Poskod/Zip Code
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Order List 订单 (Eg. daisy series violet 125/125degree *2pairs)
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Delivery Method 邮寄方式
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Pos Express
Pos Laju
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Payment Method 付款方式
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Maybank
Hong Leong Bank
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Remarks 备注
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Are you our shop's agent?
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Yes
No
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Your Agent Code
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I have read and agree to the Terms and Conditions in www.Joclensshop.blogspot.com
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Yes
No
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