FoRm TeMPaHan CoKLaT SeDaP

Name :
Email Address :
H/P Number :
Address :
Order : (Please Separate Your Order)
Payment : (Please Email To liyana.mazlan@gmail.com if required)	Maybank - 164017098897 (NURUL LIYANA BT MAZLAN) CIMB Bank - 16010025030521 (NURUL LIYANA BT MAZLAN)
Massage :
Please EMAIL payment detail to me as : - Name of Payee, Bank, Date, Time, Amount - Attach of Slip, Receipt, or Print Screen of Online Transfer Receipt. (Please ATTACH at massage box) =)

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