AEON-XPRESS Easy Payment
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AEON-XPRESS Easy Payment Application Form

We will contact you immediately upon receiving your application form.

AEON-XPRESS Easy Payment Information
Please choose one to progress application form Application Date
 
Applicant Information
  
Full name as in I.C.
New I.C. No                      Example: 851231-12-1234
Old I.C No.
Date of Birth                          Example: 31/12/1985
Gender
   
Race
     
Marital Status
 
Email Address    Example: sales@agmotor.com.my
Present Residential Address
Postcode                         State
                       
Contact No. (1)                 Example: 012-7843282
 -  
Contact No. (2)
 -  
 
No of Occupants
Years of Stay
years
months
 
Name of Company
Office Address
Postcode                                    State
                                  
Office Tel-No                         Example: 07-3329282
-
Position
Department
Nature of Business
Net Monthly Salary
RM
Salary Date
DD
DD Mid month (if any)
Length of Service
years
months
Emergency Contact Person (Individual not staying with you)
Name                            Immediate Family or Relative
Residential Address
Postcode                                    State
                                  
Relationship with applicant
House Telephone No.
-
Handphone No.                                         Example: 012-7843282
-
Office Telephone No.
-
 
Motorcycles Order Information
Motorcycles Model
Installment Period
Installment Plan
Term & Conditions
Terms and conditions
 
 
We are authorised dealer of
Honda Motor
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