ORDER FORM

Name:
Email Address:
Phone Number:
Address:
List of Order (Name, Code):
Payment Method (Please confirm whether the product is available or not before make any payment):	BANK SIMPANAN NASIONAL (0510429000170744 MOHD AQRA)
COPY & PASTE PAYMENT TRANSACTION:
PLEASE NOTE THAT I AM ONLY LOOKING FOR SERIOUS BUYER. DO NOTIFY ME (via email or SMS) AFTER SUBMIT THIS FORM. AFTER YOU HAVE RECEIVED CONFIRMATION (via email or SMS) FROM AQRA HERBALIFE, NO CANCELLATION CAN BE MADE.I WILL REPLY WITHIN 24 HOURS -AQRA HERBALIFE 0136456432-