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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 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) 

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: 017-268 0922