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Free Trial Convert Rent To Own Plan Form
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2024-05-08T14:23:10+08:00
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CUSTOMER CATEGORY
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Customer Type
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Direct Customer
iMember Customer
Landlord Customer
PERSONAL INFORMATION
Full Name
(Required)
NRIC No.
(Required)
Contact No.
(Required)
Email
(Required)
Address 1
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Address 2
(Required)
State
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JOHOR
KEDAH
KELANTAN
KUALA LUMPUR
MELAKA
NEGERI SEMBILAN
PAHANG
PENANG
PERAK
PERLIS
PUTRAJAYA
SELANGOR
TERENGGANU
LABUAN
SABAH
SARAWAK
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Postcode
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Selected Postcode
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Partner | Landlord No.
CRTO
IMEMBER
iMember Type
iMember
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Name
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NRIC No.
(Required)
REFERRAL
Referral Type
(Required)
Landlord/Biz Director/Pre Biz Director/BA
Name
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No.
(Required)
Customer Referral (Refer 5 Friends Free Ginseng pillow)
Name
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Phone No.
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REGISTERER DETAILS
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Registerer Type
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Biz Director
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Name
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No.
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VERIFICATION
Name
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No.
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DECLARATION
1. I hereby agree to purchase and fully commit to pay for the HEALTHIE DIAMOND Products Rent To Own (RTO) Contract Plan that I have purchased.
2. I fully comprehend and consent that the charges for the above-mentioned product will be billed to the credit card/bank card number specified by me.
3. I have read, comprehended, and fully agree to abide by the
terms and conditions
of the HEALTHIE DIAMOND Products Rent To Own (RTO) Contract Plan.
4. I have read and fully understand and agree that the HEALTHIE DIAMOND series products are physical therapy products that help promote micro-blood circulation. It does not have any medical efficacy or treatment of diseases. If i have any health problems, i should seek treatment from a professional doctor.
5. I understand that I have the option to personally collect the gifts provided by HEALTHIE DIAMOND or request delivery, and I am willing to bear any additional delivery charges.
6. I have read, understood and agree to the
terms and conditions
of the HEALTHIE DIAMOND Products Rent To Own (RTO) Contract Plan.
HEALTHIE DIAMOND Marketing Sdn Bhd may use your personal information to provide you with marketing communications about our products and services.
Signature
(Required)
MONTHLY RENTAL PAYMENT METHOD & DETAILS
Cardholder's Name As per Credit/Debit Card
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Issuing Bank
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HSBC
MAYBANK
OCBC
PUBLIC BANK
RHB
STANDARD CHARTERED
UOB
AEON
ALLIANCE BANK
AM BANK
CITIBANK
CIMB
EON BANK
HONG LEONG BANK
BANK SIMPANAN NASIONAL
AFFIN BANK
Credit Card/Debit Card No.
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Card Type
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Master
Visa
Type
Monthly Payment
Card Expiry Date (mm/yy)
(Required)
Full Payment
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