Farm To Home Delivery "Make Your Own Box" Order Form - Refer by Dr Yingzangel
Description
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Name *
Contactable Mobile Phone Number *
Which day you want your veggie to be delivered?  (pls double confirm with our customer service if you are ordering to be delivered on the same delivering day) *
Whatsapp Number (if different from mobile number)
FB ID (if have)
Which package you prefer and  how many pack per package? (If you  do not need a certain pack then indicate "nil")
1 Box
2 Box
Nil
Box A - Premium Box
Box B - Regular Box
Clear selection
You can select the veggies that you want to put in to your veggie box.  Please select 9 for Regular box and 15 for Premium box*CPF = Chemical Pesticide Free *CV = Carbon Veggie
Purchase With Purchase (add on)

Note: this is a fix price for veggie box customer,  if you wish to purchase ala carte,  the price might varries depends on market price.  
Other Add On (for extra Selected Veggie and PWP)
Now you can opt for pre-wash your veggie using ozone water, to disinfect and also to neutralise the chemical residue by just adding on RM6.00 only.
Do you want to do so?
Clear selection
Delivery Address (Unit, Block, Steet Name) *
Delivery Address (Seksyen, Taman) *
City *
Postcode *
Please choose which zone are you in to define your delivery fee.   Zone 1: Petaling Jaya (exclude damansara Damai), Kota Damansara,  Sri Damansara, Damansara Perdana, Desa Park, Manjarala, Subang Jaya, TTDI, Old Klang Road, Kuchai Lama, Seputeh, KL Sentral, Bangsar, Kepong, Damansara Damai, Puchong (from Jalan Puchong until Bandar Puteri Puchong)Delivery Fee: RM7.       Zone 2: Sungai Buloh, Selayang, Batu Caves, Gombak, Ampang, Cheras, Seri Kembangan, Serdang, Bukit Jalil, Sri Petaling, Puchong (after Bandsr Puteri Puchong,  Puchong Hartamas, Puchong Prima until Bandar Bukit Puchong), USJ, Shah Alam (exclude U5 and above) , Klang (before river), Ampang, Wangsa Maju, Jalan Kuching, Sentul, Wangsa Maju, Setapak, Jalan Ipoh, Mont Kiara, Bukit Damansara, Rawang (Templer Park area), Putrajaya,  Cyberjaya Delivery Fee: RM12 *
Remark
I understand that my order will be only be confirmed after payment made. Please PM the transaction slip via our Facebook page or Whatsapp to 0192353928 to confirm your order. *
Payment Mode *
You place your order via which channel ? *
Do you remember and what's the name of the person who had serviced you?  (If there is)
Submit
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