Click here to go back to Direct Order Web Page Direct Order Form (For order and delivery in Malaysia only) Name:(Mr/Ms/Mdm)_________________________ Address:______________________________              ______________________________              ______________________________ Post Code: _____________ Country : Malaysia Telephone No:____-________________ (Please indicate area code) Dear Sir, I would like to order the following products: Product Code and Description Price (RM) Quantity  Total (RM)   1. Model A1010 Back Pillow For Sleeping 78.00     2. Model A1020 Neck Pillow For Sleeping 78.00     3. Model A1030 Back Pillow For Car Seat 27.00     4. Model A1040 Neck Pillow For Car Seat 27.00     5. Model A1050 Back Pillow For Chair 27.00     6. Model A1060 Neck Pillow For Chair 27.00     7. Model B1010 Dr. Jun's Herbal Cleanse 39.00     8. Model B1020 Dr. Jun's Junopain 45.00     9. Model C1010 Encyclopaedia of Chinese     Unique Non-medical Therapy 81.00     10. Model C1020 The Guide Book For Stroke      and Restroke 12.00       Courier Charges (Please refer to Purchase Web Page)   TOTAL   Enclose a copy of Cheque/Bank Draft No : __________ Bank: ________________________________ Thank you. ________________ Name: Date: Please send to: Jun Xi Sdn Bhd No. 13 Jalan SS 18/1B, Subang Jaya, 47500 Selangor, Malaysia Tel: 03-5631 9899 or 03-5633 1899 Fax : 03-5637 9007