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Hydrogen Water Machine Free Trial Register Form
nick_yu
2025-11-27T13:10:09+08:00
Hydrogen Water Machine Free Trial Registration Form
Selected Products
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Validation
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Products
Mattress Pad
CUSTOMER CATEGORY
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CUSTOMER CATEGORY
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Customer Type
(Required)
Biz Director
Landlord
SPartner
iMember
BA
Direct Customer
PERSONAL INFORMATION
PERSONAL INFORMATION
Full Name
(Required)
NRIC No.
(Required)
Contact No.
(Required)
Email
(Required)
Address 1
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Address 2
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State
(Required)
Please Select
JOHOR
KEDAH
KELANTAN
KUALA LUMPUR
MELAKA
NEGERI SEMBILAN
PAHANG
PENANG
PERAK
PERLIS
PUTRAJAYA
SELANGOR
TERENGGANU
LABUAN
SABAH
SARAWAK
City/Town
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Selected City
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Postcode
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Selected Postcode
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Partner | Landlord No.
MFT
REFERRAL
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IMEMBER
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iMember Type
(Required)
iMember
Non-iMember
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Name
(Required)
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NRIC. (example: 112233445555)
(Required)
REFERRAL
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Referral Type
(Required)
Landlord/Biz Director/Pre Biz Director/Biz Partner/BA
Name
(Required)
No.
(Required)
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Customer Referral (Refer 5 Friends Free Ginseng pillow)
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Name
(Required)
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Phone No.
(Required)
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REGISTERER DETAILS
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Registerer Type
(Required)
Biz Director
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Name
(Required)
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No.
(Required)
VERIFICATION
SALES PERSON
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Verification Type
(Required)
Biz Partner
Biz Director
Name
(Required)
No.
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Signature
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Selected Payment
DECLARATION
DECLARATION
Under the HEALTHIE DIAMOND Free Experience Plan, the Customer shall be entitled to and agrees to be bound by the following terms and conditions:
1. HEALTHIE DIAMOND Marketing Sdn Bhd ([202301024016 (1517939-H)] (“the Company”) is hereby the proprietor of the HEALTHIE DIAMOND Experience Plan.
2. Under the HEALTHIE DIAMOND Experience Plan, the ownership of the HEALTHIE DIAMOND(Product) Hydrogen Water Machine remains with the Company throughout the entire duration of the Free Experience.
3. The customer is responsible for returning the product in good condition within 14 days after the experience plan ends.
4. The deposit will be refunded to the customer after 45 days of returning the product.
5. The Company has the right to substitute any of the Free Gifts Products awarded under the HEALTHIE DIAMOND Free Experience Plan with another product of similar value at any time without prior written notice being given.
6. The Free Gift Products awarded is not applicable for exchange to cash considerations.
7. The Customer is eligible to use eCash rewards (“the eCash”) for purchases in the eMall only, subject to the terms and conditions of the eMall.
8. The eCash will be valid for a period of one (1) year(s) from the date of crediting of the eCash in their eMall account.
9. The eCash is non-exchangeble for cash or any other forms of legal tender.
10. Any rights not explicitly granted herein are retained by HEALTHIE DIAMOND.
11. HEALTHIE DIAMOND reserves the right to variations of the terms and conditions herein at any time without prior consent given.
12. I have read and fully understand and agree to be abided by the terms and conditions of the HEALTHIE DIAMOND Experience Plan.
Signature
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MONTHLY RENTAL PAYMENT METHOD & DETAILS
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Cardholder's Name As per Credit/Debit Card
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Issuing Bank
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Please Select
HSBC
MAYBANK
OCBC
PUBLIC BANK
RHB
STANDARD CHARTERED
UOB
AEON
ALLIANCE BANK
AM BANK
CITIBANK
CIMB
EON BANK
HONG LEONG BANK
BANK SIMPANAN NASIONAL
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Credit Card/Debit Card No.
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Card Type
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Master
Visa
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Type
HRTN
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Card Expiry Date (mm/yy)
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Full Payment
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