EmailMe Form - YYINGSHOP Order Form

Full Name *
Email Address *
Phone *
Address
Order and Prescription x Quantity *
Example (Contact Lens):

Fairy Grey 250/500 x1
Dreamy.i Brown 0/0 x2
Form of Payment *
Maybank BEH YIT YING 107096309107
Public Bank BEH YIT YING 4-5500802-36
Paypal (International buyers)
Cash-on-Delivery (Specific areas)
Shipping Methods *
Pos Laju
Skynet
Cash-on-Delivery (Specific areas)
EMS (International buyers)
Remarks
Image Verification

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