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Direct Order Form
(For order and delivery in Malaysia only)

Post Code: _____________
Country : Malaysia
Telephone No:____-________________ (Please indicate area code)

Dear Sir, I would like to order the following products:
Product Code and DescriptionPrice (RM)
Refer web page
Quantity Total (RM)  
1. Model A1010 Back Pillow For Sleeping   
2. Model A1020 Neck Pillow For Sleeping    
3. Model A1030 Back Pillow For Car Seat    
4. Model A1040 Neck Pillow For Car Seat    
5. Model A1050 Back Pillow For Chair   
6. Model A1060 Neck Pillow For Chair   
7. Model A1070 Travel Pillow   
8. Model B1010 Jun Xi Herbal Cleanse   
9. Model B1020 Jun Xi Junopain    
10. Model C1010 Encyclopaedia of Chinese
    Unique Non-medical Therapy
11. Model C1020 The Guide Book For Stroke
     and Restroke
Courier Charges (Please refer to Purchase Web Page) 


Enclose a copy of Cheque/Bank Draft No : __________
Bank: ________________________________

Thank you.


Please send to:
Jun Xi Sdn Bhd
No. 13 Jalan SS 18/1B, Subang Jaya, 47500 Selangor, Malaysia
Tel: 017-268 0922