SariStemCell

Al-Qur'an Cordoba

On-Line Forms


(A). ON-LINE REQUEST TO BUY PRODUCTS

Pls 1. Complete the form below with the required particulars;2. Bank-in the payment (pls include packaging & courier cost**) to my MBB account No. 164164001535;3.SMS me for shipping purposes.
** Packaging & Courier Cost 1-2 Items:- RM9 WM/RM12 EM; 3-4 Items:- RM12 WM/RM17 EM
Product Ordered (Produk Dipesan) ** Order more than 26PV plus RM8 Mktg Tools Package for free lifetime membership worth RM35 WM/ RM40 EM. Pesanan yang melebihi 26PV dan Mktg Tools Package (RM8) melayakkan anda menjadi ahli seumur hidup secara percuma yg bernilai RM35 WM/ RM40 EM)    
Quantity (Kuantiti)
Name (Nama):
MyKad No. (Optional):
E-mail (E-mel):
Phone Number (Nombor Telefon):
Full Address (Alamat Lengkap):
Comment (Komen):

For further details, pls contact:-
Utk keterangan lanjut sila hubungi:-

BURHANUDDIN SAIDIN
6 Star Goji Manager
8, Jalan PJS 1/2B, Taman Perangsang,
46150 Petaling Jaya,
Selangor Darul Ehsan.
sburhan8amn@gmail.com
+6016-6596011


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(B). ON-LINE REQUEST TO BECOME A DISTRIBUTOR

To apply as a distributor, please
(1). Complete the form below with the required particulars;
(2). Bank-in the payment to my MBB account No. 164164001535;
(3). Inform me immediately;
(4). I will contact you for distributor registration purposes. ** Order more than 26PV plus RM8 (WM); RM10 (EM) for mktg tools package for free membership without paying membership fee of RM35 for WM/ RM40 for EM. Thanks for your co-operation.

[Utk memohon menjadi pengedar, sila
 (1). Lengkapkan borang permohonan dengan maklumat yang diperlukan;
(2). Bank-in pembayaran anda ke dalam akaun MBB No. 164164001535;
(3). Maklumkan saya dengan kadar segera; (4). Saya akan menghubungi anda semula utk tujuan pendaftaran sebagai pengedar. ** Untuk menjadi ahli secara percuma tanpa perlu membayar yuran ahli RM35 utk WM/ RM40 utk EM, sila pesan produk yang melebihi 26PV dan mktg tools (RM8 (WM); RM10 (EM) .Terima Kasih].
Have you or your spouse been a HEALTH BUILDERS distributor before? (Adakah Anda atau Pasangan anda pernah menjadi Pengedar HEALTH BUILDERS sebelum ini? : Yes (Ya)
 No (Tidak)

Membership Registration Fees (Yuran Pendaftaran Keahlian) : WM RM35.00 / EM40.00
Applicant's Name (Nama Pemohon):
IC No. (No. K/P):
Date of Birth (Tarikh Lahir)

Example (Contoh): 16-01-1995
Sex (Jantina): Male (Lelaki)
 Female (Perempuan)
Race (Bangsa):
Postal Address in Full including Postcode(Alamat Lengkap Surat Menyurat termasuk Poskod):   
Email Address:
Handphone No. or House Tel. No. (No. HP atau No. Telefon Rumah):
Name of Beneficiary - Husband/Wife/Family (Nama Pewaris - Suami/Isteri/Keluarga)
IC No. (No. K/P):
Date of Birth (Tarikh Lahir):
Sex (Jantina): Male (Lelaki)
 Female (Perempuan)
Race (Bangsa) :


Sponsor's Name (Nama Penaja) : Burhanuddin Saidin
Code No. (No. Kod) : 60300
Products Ordered (Produk yang dipesan)  Note: Pls ensure the total PV is 26 and above (Sila pastikan jumlah PV adalah 26 dan ke atas)
Comment/Feedback (Komen/Maklumbalas)   

For further details, pls contact:-Utk keterangan lanjut sila hubungi:-BURHANUDDIN SAIDIN8, Jalan PJS 1/2B,Taman Perangsang,46150 Petaling Jaya,Selangor Darul Ehsan.sburhan8amn@gmail.com+6016-6596011


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