BORANG PESANAN/ORDER FORM
Pembayaran boleh dibuat melalui/The payment can be made by:

Dari Malaysia/From Malaysia:

(i) Tunai/Cash
(ii) Wang Pos/Postal Order
(iii) Cek/Cheque

Luar Negara/Overseas:
(iv) Bank Deraf/Bank Draft

* The Payment must be paid under the name of Director of Institute for Medical Research
Judul Penerbitan/Title of Publication: *
Your answer
Salinan Pembelian/Copy of Purchase *
Your answer
Nama Penuh/Full name: *
Your answer
Nama Syarikat/Company Name:
Your answer
Alamat Penuh/Full Address: *
Your answer
Poskod/Post Code: *
Your answer
Nombor Telefon/Phone Number: *
Your answer
Nombor Faks/Fax Number:
Your answer
E-mel/E-mail: *
Your answer
Pesanan/Order *
Sendiri Ambil/Self Pick Up/Kurier/Courier
Your answer
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