CS Society Merch Cart

Full name

Matric number

Student Outlook e-mail

Contact number

Country code

Gender

Female

Male

Year of study

Year 1

Year 2

Year 3

Year 4

Collection method

Pick up (on-campus only)

Ship (within Malaysia only)

Item	Qty	Amount

Please bank in the total amount to:

Account number: 220088870689

Accountholder name: NOR AISYAH BINTI AMRAN

Bank name: Bank Rakyat

Reference: CSMerch MATRIC_NUM

Upload receipt screenshot file

.png, .jpg, .jpeg, .pdf

I understand that all my information submitted via this form will be kept securely and only used for CS Society merchandise purposes.*

I have double-checked and confirmed that all the given information & paid amount are accurate.*