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 TYPEPURE WHITE

LONG TYPEPLATINUM SILVER

LONG TYPEBABY PINK

LONG TYPEPREMIUM BLACK

SHORT TYPEPURE WHITE

SHORT TYPEPLATINUM SILVER

SHORT TYPEBABY PINK

SHORT TYPEPREMIUM BLACK

Current choose dispenser
SIZE: LONG TYPE
COLOR: PURE WHITE

type

Water dispenser long type

LONG TYPE

LONG TYPE

H130cm×W30cm
×D35cm

SHORT TYPE

SHORT TYPE

H85cm×W30cm
×D35cm

Select colorrequired

 

PURE WHITE

 

PLATINUM SILVER

 

BABY PINK

 

PREMIUM BLACK

Select dispenser plan

Select planrequired

Rental

FREE

(Pay for deposit S$ 200)

Buy

S$ 290(+TAX)

arrow

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

Please enter number of bottles and 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

※required field.

Categoryrequired    Please enter Division.
Namerequired
Please enter Full name.
Genderrequired   
Date of Birthrequired 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
Delivery address required
Namerequired
Postal coderequired
Addressrequired
Phone/Mobilerequired

※no hyphen

number might use for delivery issue.

Payment

  

※We will send payment detail by e-mail after the initial delivery completion

Service Agreement

required