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MEDIEN SDN BHD (960007-U)
105-07-06, Hexagon Tech Park, Jalan Gurdwara, Georgetown 10300
Malaysia
Tel : 1800182899
Email : office@medien.com.my
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RECURRING PAYMENT DETAILS |
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| Pay to Merchant |
MEDIEN SDN BHD |
| Amount |
MYR 469.00 |
| Number of Payments to be made |
24
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| Frequency |
Monthly |
| Product Description |
PRODUCT NO.:OX-1A-E |PRODUCT DESC.:VENUS 5 POC|MANUFACTURER:OXTM |RTO TENURE:24MONTHS |RTO NO.:RTO_OXTMV51.0240722-24 |
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| CREDIT CARD DETAILS |
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| First Payment Date |
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| Name On Card * |
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| CreditCard No. * |
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| CreditCard CVV * |
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| Card Expiry Date * |
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| CreditCard Issuer Country * |
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| CreditCard Issuer Bank * |
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| Identity Card No / Passport No * |
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| Card Holder Email * |
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| Card Holder Contact * |
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| Recurring Reference * |
Remark for your recurring payment, maximum 30 characters only. (eg. Donation, Payment for insurance plan, Bill payment)
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| Other Payment Details |
Description of purpose or other info related to your recurring payment, maximum 50 characters only. (eg. Monthly payment for my insurance plan)
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| PERSONAL DETAILS |
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Tick if Personal Information and Credit Card details are the same |
| Customer Name * |
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| Customer Email * |
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| Customer Phone No. * |
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| Customer Address * |
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| Customer Address Line 2 |
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| City * |
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| State/Province * |
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| ZipCode * |
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| Country* |
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| Clicking I accept means you agree to the terms and condition. And you also agree that NTT DATA Payment Services (formerly known as iPay88 Sdn Bhd) will charge your credit card for the amount and type of payments stated above. |
| *Required |
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