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Back To Basics Payment Notification Form
Dear Valued Customer,
Thank you for your order and payment!
In order for us to process your order in a timely manner, we need your payment transfer information.
Please provide us with the following details in the numbered order in the information box below:
*Note that your name and email address should be identical to the one given in your account details.
1. Order Date
2. Payment Date
3. Your Payment Bank
4. Payment Mode (e.g. online transfer, ATM bank-in, etc)
5. Amount Paid (RM)
6. Any comments
Name
*
First
Last
Email Address
*
Information Box
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