Order Form

Date

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

Upload your NRIC Front Side

Browse Files

Set Label 'For Vasayo Order Only'

Ship Method

Shipping Address (For Delivery Only)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Product List

Individual Products

Eternal590.00 MYR

(Sachets, 30ml/sachet)

Quantity

VS498.00 MYR

(30 sticks, Net weight 8g/sachet)

Quantity

Veuro315.00 MYR

(60ml/bottle)

Quantity

BELEZA Serum680.00 MYR

(30 /1fl.oz)

Quantity

BELEZA Rejuvenating Cream340.00 MYR

(50ml/1.7fl.oz)

Quantity

BELEZA Hydrating Mist340.00 MYR

(100ml/3.4fl.oz)

Quantity

Total 0.00 MYR

Payment Information

Type of Payment

A RM15 of shipping fees will be charged shipping delivery

Cardholder's Name

Applicable only for Debit/Credit Card Payment

Card Number

Applicable only for Debit/Credit Card Payment

Card Expire Date

Applicable only for Debit/Credit Card Payment

Upload Proof of Payment

Browse Files

Signature

Payment Agreement

Third Party Card Holder's Information

Full Name

First NameLast Name

NRIC No.

Phone Number

Area CodePhone Number

Email

example@example.com

Signature

Pickup Agreement

Third Party Pickup Information

Self Pickup do not require to fill up the information below.

Full Name

First NameLast Name

NRIC No.

Phone Number

Area CodePhone Number

Email

example@example.com

Signature