Order Form

Membership ID *for membership ONLY!
Name:
Contact number
Email Address:
Address
Preferred Bank?	Maybank CIMB Muamalat
Delivery Method	I agreed that my parcel will be delivered by POS LAJU
For COD ONLY!!	Seberang Jaya UIAM
Items Code
I understand and agreed the terms & condition that have been mentioned by De'anza Shop	I agree!

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