PREMIUM WATER Order Form - Select a Water Dispenser and a Plan

  •      Order details
  •      Confirmation
  •      Completion

All information that you key in on the site will be protected and kept confidential through the use of SSL.

Product choice

Dispenser type and color

LONG TYPEWHITE

LONG TYPE

LONG TYPEBROWN

LONG TYPEBLACK

SHORT TYPEWHITE

SHORT TYPEBROWN

SHORT TYPEBLACK

Current choose dispenser
anadana standard TYPE
COLOR:

type

amadana Standard TYPE

amadana standard type

H132cm x W26.5cm
x D31.3cm

amadana standard TYPE

amadana standard TYPE

H132cm×W26.5cm
×D31.3cm

SHORT TYPE

SHORT TYPE

H85cm×W30cm
×D35cm

Select colorrequired

 

WHITE

 

BROWN

 

BLACK

Select dispenser plan

Select dispenser planrequired

Rental

FREE

(Pay for depositS$200 )

Buy

S$ 290(+TAX)

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Water 1set (12L water, 2 bottles) price

(without tax)

water price S$30 × 2bottles 1 set(12L×2) S$60

Delivery information

Delivery schedule

Please set first water and dispenser delivery date.required

First delivery date Please enter First delivery desire. ※Water and dispenser will deliver same time.
First delivery hours

Please enter number of bottles and delivery frequency after first delivery.required

Frequency of delivery Please enter Delivery period time. , Please enter Delivery desire date. You can change delivery schedule anytime on MYPAGE site.
Delivery hours
Please enter Delivery time.
Number of bottles per delivery Please enter Number of delivery. bottles ※Order quantity as 2 per unit.

Customer Information

Categoryrequired    Please enter Division.
Namerequired
Please enter Full name.
Genderrequired   
Birth of daterequired Day Month Year
Departmentrequired
Contact Namerequired
Postal coderequired
Addressrequired
Phone/Mobilerequired

※no hyphen

number might use for delivery issue.
Email Addressrequired
Please enter Email.
as MYPAGE login ID.
Passwordrequired

※letters and digits, at least 8.

as MYPAGE login password.
Remarks
*If you have coupon, write here.
Delivery addressrequired
Receipent Namerequired
Destination Postal coderequired
Destination Addressrequired
Destination phone numberrequired

※no hyphen

number might use for delivery issue.

Payment

     



Service Agreement


required