CUSTOMER’S ORDER FORM
( Koperasi Guru Sarawak Berhad )
139A (Ground Floor) Rock Road, 93200 Kuching,
Sarawak.
Tel: 082-411780 Fax: 082-245757
NAME : _________________________________ I.C NO :
______________________
CONTACT NO. : ______________________
( R ) ________________________
( H )
MAILING
ADDRESS : ____________________________________________________
____________________________________________________
____________________________ POSTCODE : ____________
EMAIL ADDRESS :
_______________________________
SCHOOL IN SERVICE
: __________________________________________________
__________________________________________________
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Total
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Amount Paid RM ________________ ( Cash/ Money/Postal Order / Cheque
) No. ___________
Verified by: ______________________ Name: _________________________ ( Koguru
)
Referer’s Name ( if any ) :
____________________________ Contact No. _________________
Signature: ____________________________ Date: ___________________