CITY Founding Partner License Order Form

Selected Products

Validation

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Products

PERSONAL INFORMATION

Full Name(Required)

NRIC No. / Passport No.(Required)

Contact No.(Required)

Email(Required)

Address 1(Required)

Address 2(Required)

State(Required)

City/Town(Required)

Selected City(Required)

Postcode(Required)

Selected Postcode(Required)

Partner | CITY Founding Partner No.

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IMEMBER

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Referral Type

iMember

Non-iMember

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Name

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NRIC No.

Biz Director / Referral

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Registerer Type(Required)

C Partner / Biz Director

Name(Required)

Partner Code(Required)

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Referral

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Name

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Referral Code

REGISTERER DETAILS

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Verification Type(Required)

Biz Director

Name(Required)

No.(Required)

Selected Payment

DECLARATION

1. I hereby agree to purchase and agreed to pay for the BIG PLAN and Products that I have purchased.
2. I consent that the monthly charges for the above-mentioned product will be charged to the credit card/bank card number indicated on the agreement.
3. I have read, and fully understand and agree to abide by the terms and conditions of the BIG PLAN and Products.
4. I understand that I have the option to personally collect the gifts or request delivery, and I am willing to bear any additional delivery charges.
5. I have read, understood and agree to the terms and conditions of the BIG PLAN and Products.

BANK ACCOUNT INFORMATION

Account Holder Name(Required)

Beneficiary Bank(Required)

Bank Account No.(Required)

Account Type(Required)

Current Account

Saving Account

UPLOAD FILE

Please upload Order Form Softcopy(Required)

Max. file size: 10 MB.