JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID19 CHARITY EDUCATION CROWDFUNDING_order form
GoCare 与 Energy Depot 携手合作，共同筹募教育基金。
GoCare is now collaborate with Energy Depot, to raise fund for education.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
NAME (ENGLISH)
*
Your answer
SHIPPING ADDRESS
*
Your answer
HANDPHONE NUMBER
*
Your answer
SHIPPING METHOD
*
Free Shipping
Self pick up @ GoCare Office( Wisma MCA KL)
Self pick up @ Energy Depot Office (Selayang)
DONATION PACKAGE
*
Early Bird Package (RM50 ) : 3ply-medical mask (50 pcs) + 100pcs Alcohol Wipes (Limited 50 sets only!)
Package 1 (RM65 ) : 3ply-medical mask (50 pcs) + 100pcs Alcohol Wipes
Package 2 (RM100) : 3ply-medical mask x 2 boxes (100 pcs) + 100pcs Alcohol Wipes
Package 3: (RM200) : 3ply-medical mask x 4 boxes (500 pcs)+ + 200pcs Alcohol Wipes + 5pcs Face Shield
Package 4: (RM500) : 3ply-medical mask x 12 boxes ( 600 pcs)+ + 300pcs Alcohol Wipes + 5pcs Face Shield
Other:
Donation ticket number (IF ANY, FOR GOCARE ONLINE PAYMENT ONLY, KINDLY CHECK YOUR EMAIL)
Your answer
Remarks
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
