Date: ......./......./.......

Customer Details
Membership No : ..............................................
Full Name : ........................(First Name) ...........................(Surname)
Full Mailing Address : .............................................................................................
.......................................................................................................................................
Contact Tel No : ........................ Fax No : ........................Email Address(if any) : .............................

Order Details     (N: Normal Price      PR: Privilege Price)
Product ID
Product Picture
Product Descriptions
Quantity
Unit Price($)
Total Price($)
ALBT3FA70
Tea Tree - Rose Hip Oil Liquid Skin Cleanser 70ml   N RM 10.00 / 
USD 2.65 		 
  PR RM 9.00 /
USD 2.40 		 
ALBGT3S70
Grapsede T-TR33 Facial Scrub Cleanser 70ml    N RM 11.60 / 
USD 3.05  		 
  PR RM 10.45 / 
USD 2.75  		 
ALBSENWA100 
Tea Tree - Rose Hip Sensitive Skin Wash 100ml   N RM 10.45 /
USD 2.75  		 
  PR RM 9.40 / 
USD 2.50  		 
ALBBBYW100
Tea Tree - Rose Hip Skin Wash for Baby 100ml   N RM 10.45 / 
USD 2.75 
 
  PR RM 9.40 / 
USD 2.50 
 
ALBRTSP120
Rose Hip - Tea Tree Thick Hair Shampoo 120ml   N RM 10.45 / 
USD 2.75 		  
  PR RM 9.40 / 
USD 2.50  		 
ALBRTCD100
Rose Hip - Jojoba Thick Hair Conditioner 100ml   N RM 10.50 /
USD 2.80 		 
  PR RM 9.45 /
USD 2.50   		   
ALBT3FA100
Tea Tree - Rose Hip Oil Premium Skin Cleanser 100ml   N RM 20.50 /
USD 5.40 		 
  PR RM 18.45 /
USD 4.85 		 
ALBGT3S100
Grapsede T-TR33 Premium Facial Scrub Cleanser 100ml   N RM 22.10 /
USD 5.85 		 
  PR RM 19.90 /
USD 5.25   		 
ALBBBYW300
Tea Tree - Rose Hip Skin Wash for Baby 300ml   N RM 30.00 /
USD 7.90
 
  PR

RM 27.00 /
USD 7.10

  
ALBRHPO15
Rose Hip Oil Pure 15ml   N RM 50.55 /
USD 13.30
  
  PR RM 43.00 /
USD 11.30
 
ALBSKRV10
Skin Revitalising Oils 10ml   N RM 20.55 /
USD 5.40 		 
  PR RM 18.50 /
USD 4.90   		 
ALBORT310
Australian Organic Tea Tree Oil 10ml   N RM 17.40 /
USD 4.60
 
  PR RM 14.80 /
USD 3.90 		 
ALBRJLOT100
Rose Hip - Jojoba Dry Skin Rejuvenating Lotion 100gm   N RM 16.00 /
USD 4.20
 
  PR RM 14.40 /
USD 3.80
 
ALBRHRJ30
Australian Rose Hip Oil Rejuvenating Cream 30gm   N RM 35.00 /
USD 9.25
 
  PR RM 30.00 /
USD 7.90   		 
ALBEPOCM45
Australian EPO Moisturizing Cream 45gm   N RM 11.30 /
USD 3.00		  
  PR RM 9.60 /
USD 2.55 		 
ALBSTCM50
Australian Rose Hip - Jojoba Stretch Mark Cream 50gm   N RM 10.00 /
USD 2.65 		 
  PR RM 9.00 /
USD 2.40 		 
ALBDEMB50
DermaMoist Baby Skin Cream 50gm   N RM 6.10 /
USD 1.60 		 
  PR RM 5.50 /
USD 1.45 		 
  G/Total:  

 Payment Details:
*Maybank2u.com(for Malaysians only). Please call us 03-78474812 for details.
Maybank Acc:...................................... Total Amount transferred: ....................
*Bank draft / postal order / Money Order :................................Total amount paid:.............................
*Credit Card (Please select one). I authorised Auslab Laboratory (M) Sdn Bhd to debit the above amount to my credit card below with details :-
Master Card / Visa Card Card No:............................................
Name on credit card:............................................
Expiry Date:................... Signature:............................................

Please fax your order & payment details to +60 3 78467623 between 10.30am to 9.00pm Mon to Sat, or mail by post to: Auslab Laboratory (M) Sdn Bhd, P O Box 7341 Post office Besar Shah Alam, 40712 Shah Alam, Selangor DE, Malaysia **To make sure we receive your order and to speed up our processing, you can call us at 03-78474812 to check on the status of your order.