CS-F19

REV.0

LRC TECH (M) SDN BHD

(819359-A)

Lot 9896-B, Jalan Kampung Jawa, Batu 4, Kampung Jawa, 40460 Shah Alam
Tel: +6 03 5161 3799 Fax: +6 03 5162 3711 Email: lrcinside Website: www.lrc.com.my

AD CONFIRMATION OF ORDER
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|__| Own collection

AD: ____________________________________________________________

|__| CSL delivery : ________ (Deliver to ADs address)

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D|__|__|__|__|__|/|__|__|-CF/ D|__|__|/ 10

Order Details
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Terms & conditions as per AD agreement.

Issued by

Please place your company stamp and your signature below to confirm
the order.
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Date:
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CS-F19
REV.0

LRC TECH (M) SDN BHD

(819359-A)

Lot 9896-B, Jalan Kampung Jawa, Batu 4, Kampung Jawa, 40460 Shah Alam
Tel: +6 03 5161 3799 Fax: +6 03 5162 3711 Email: lrcinside Website: www.lrc.com.my

-/ Comtinue
AD:
___________________________________________________

CF#:

D|__|__|__|__|__|/|__|__|-CF/ D|__|__|/ 0 8

st

(Delivery Details refer to 1 page)

Item

Model No. / Serial No.

Qty

Unit

U.Price

Amount

Sub-total this page:

REMARKS

Page |___|:
Sub-Total / Total:
Continue next page: |__| (pls tick)

Terms & conditions as per AD agreement.

Issued by

Please place your company stamp and your signature below to confirm
the order.
Company Stamp:

Date:

CS-F19
REV.0

LRC TECH (M) SDN BHD

(819359-A)

Lot 9896-B, Jalan Kampung Jawa, Batu 4, Kampung Jawa, 40460 Shah Alam
Tel: +6 03 5161 3799 Fax: +6 03 5162 3711 Email: lrcinside Website: www.lrc.com.my

Acc Dept Use

Signature: ________________________________________________
Date: