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Cuckoo Form

This document appears to be a sales order form containing customer information such as name, contact details, emergency contact, and address. It also includes details of products purchased such as water purifiers, air purifiers, and blenders along with quantities and prices. Payment information is provided including options for outright payment, rental plans, credit/debit card information, and preferred payment methods such as direct debit or cash. An installation date is requested and signatures are required from both the customer and a representative.

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Haslinda
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598 views1 page

Cuckoo Form

This document appears to be a sales order form containing customer information such as name, contact details, emergency contact, and address. It also includes details of products purchased such as water purifiers, air purifiers, and blenders along with quantities and prices. Payment information is provided including options for outright payment, rental plans, credit/debit card information, and preferred payment methods such as direct debit or cash. An installation date is requested and signatures are required from both the customer and a representative.

Uploaded by

Haslinda
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sales Order No.

DATE NE ID : _______________
CUSTOMER PARTICULAR
NAME AS PER I/C : ____________________________________________________________________
I/C NUMBER : ___________________________________________
BILLING ADDRESS : ____________________________________________________________________
___________________________________________ POSTCODE: ________________
INSTALLATION ADDRESS : ____________________________________________________________________
___________________________________________ POSTCODE: ________________
CONTACT INFO : __________________ (H/P) __________________ (H) __________________ (O)
EMAIL ADDRESS : __________________________________________

SEX : MALE □ FEMALE □


CUSTOMER EMERGENCY CONTACT PERSON
NAME AS PER I/C : ____________________________________________________________________
CONTACT INFO : __________________ (H/P)
RELATIONSHIP : __________________

PRODUCT MODEL & PAYMENT INFORMATION


PRODUCT QTY RM PRODUCT QTY RM PRODUCT QTY RM
WATER PURIFIER FUSION STAND □ BLENDER
MARVEL □ DELUXE □ MAX BLENDER □
KING TOP □ JAZZ □ REMARK
IRIS TOP □ AIR PURIFIER
FUSION TOP □ B-MODEL □
ICON □ C-MODEL □
OUTRIGHT NORMAL PLAN 18 30 48 72
RENTAL GOOOD PLAN 24 36 60 84
DEBIT/ CREDIT CARD/ ACC. NO. :
ISSUED BY : _______________ EXP DATE: _____MM/_____YY
NAME ON CARD : _____________________________________________
PAYMENT INFO
DIRECT DEBIT □ EPP REMARK
CASH □ 6 □ 24 □
CHEQUE □ 12 □ 36 □
PREFERRED INSTALLATION DATE : / / (DD/MM/YY)
SIGNATURE

CUSTOMER NAME : DATE :


I/C NO. :
FOR INTERNAL USE
REMARKS :
ORDER NO. :
RESELLER/ NATURAL EXECUTIVE NAME :
RESELLER/ NATURAL EXECUTIVE CODE :

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