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Order Form for Private or Business Use

1.0 Order Form

[back to top]

Download and Submit to [email protected] Your Order Form or Complete the Online Form below:

STEP 1: Select Type of Purchase Personal Use Starter Business Power Business

Personal Order of 1 Unit Only	RM 100.00/unit	Enter Units Order #
Starter Business Order of minimum 10 Units	RM 480.00/unit	Enter Units Order #
Power Business Order of minimum 200 Units	RM 450.00/unit	Enter Units Order #

STEP 2: Purchaser Details
Full Name: surname in capital letters
Identification Card:		MaleFemale
Date of Birth:
Driving License Number: dd/mm/yyyy
Driving License Expiry Date: dd/mm/yyyy

Address on Identification Card: (TERMS: Extreme Power Energy sent to this address)


City/Town:	PostCode:
State:	Country:
Telephone:	Mobile Phone:
Email: (TERMS: Order and Confirmation by email)

STEP 3: Car Details
Brand:	Model:
Date Purchased:	Warranty End Date:
Engine Number:	Is This Company Owned?: YesNo
IF YES,	Company Name:
	Company Manager:
	Company Phone No.:

* IMPORTANT TERMS:

1) ONLY FULLY COMPLETED FORMS ACCEPTED.

2) SCAN FORMS TO SEND TO [email protected] ALONG WITH COPY OF DRIVING LICENSE, CONFIRMATION WILL BE SENT FROM THIS EMAIL ADDRESS ALONG WITH PAYMENT INSTRUCTIONS.

3) PAYMENT MUST BE RECEIVED BEFORE SENDING OF PACKAGE. COPY OF BANK PAYMENT SLIP MUST BE SENT TO [email protected].

4) NO WARRANTY PROVIDED TO CAR USING EXTREME POWER ENERGY.

5) ALLOW AT LEAST 10 WORKING DAYS FOR DELIVERY. WE WILL SEND POST LAJU DELIVERY SLIP TO YOUR EMAIL ADDRESS.

Please Type Out Your Name in Exact to Above to ACCEPT and CONFIRM This Order and Terms
Date of Above Confirmation

OFFICE USE: ACCEPT / RECEIVED LICENSE / RECEIVED PAYMENT / RECEIVED PAYMENT SLIP COPY / RECEIVED EXTREME POWER ENERGY / SENT OUT TO APPLICATION / CONFIRMATION BY POS LAJU

1.2 Contact Us [back to top]

Corporate Address:
  12, Taman KingFisher Phase 2,
  88450 Likas,
  Kota Kinabalu, Sabah,
  Malaysia.

Phone:
  +60 12 8388653
        (from 10am-2pm, and 7pm-9pm local time - Monday to Sunday)