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First Name (Given Name): [Compulsory - No initial or short forms allowed ]
Last Name (Surname / Family Name): [Compulsory - No initial or short forms
allowed ]
City, Province, State
(Where you staying at now): [Compulsory]
Country (Where you staying at now, NOT where you originated
from): [Compulsory]
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTARCTICA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA AND HERZEGOWINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLOMBIA
COMOROS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS (MALVINAS)
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MCDONALD ISLANDS
HOLY SEE (VATICAN CITY STATE)
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN, ISLAMIC REPUBLIC OF
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA, NORTH
KOREA, SOUTH
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEMOCRATIC REPUBLIC
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA, FEDERATED STATES OF
MOLDOVA, REPUBLIC OF
MONACO
MONGOLIA
MONTSERRAT
MOROCCO
MOZAMBIQUE
MYANMAR
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PALESTINIAN TERRITORY, OCCUPIED
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT KITTS AND NEVIS
SAINT LUCIA
SAINT PIERRE AND MIQUELON
SAINT VINCENT AND THE GRENADINES
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
SUDAN
SURINAME
SVALBARD AND JAN MAYEN
SWAZILAND
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN
TAJIKISTAN
TANZANIA, UNITED REPUBLIC OF
THAILAND
TIMOR-LESTE
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
UNITED STATES MINOR OUTLYING ISLANDS
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIETNAM
VIRGIN ISLANDS, BRITISH
VIRGIN ISLANDS, U.S.
WALLIS AND FUTUNA
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
Others
Which e-Currency required: [Compulsory]
Buy Payza USD (Personal Starter Only)
Buy Payza USD (Personal Pro/Business Only)
Buy c-Gold USD
Buy Liberty Reserve EUR
Buy Liberty Reserve USD
Buy Liqpay EUR
Buy Liqpay USD
Buy MoneyBookers USD
Buy OKPay USD
Buy PayPal Balance (Personal Account Only)
Buy PayPal Credit Card (Premier/Business Only)
Buy Pecunix USD
Buy Perfect Money EUR
Buy Perfect Money USD
Buy SolidTrustPay USD
Amount Required and currency: [Compulsory]
USD
SGD
RM
INR
AUD
EUR
PHP
THB
e-Currency account number / ID + account
name : [e.g U8566123 (Ah
Teck ) or alvin@hotmail.com (Ah Teck Alvin Lee)]) ]
(Ensure the
account number
/ ID + account name are
correct!)
Phone Number: (Compulsory: select country code , e.g Mobile
+65-96372653 )
Mobile
Home Fixed Line
Office Fixed Line
Choose country code...
Afghanistan +93
Albania +355
Algeria +213
American Samoa +1684
Andorra +376
Angola +244
Anguilla +1264
Antarctica +672
Antigua +1268
Argentina +54
Armenia +374
Aruba +297
Ascension +247
Australia +61
Austria +43
Azerbaijan +994
Bahamas +1242
Bahrain +973
Bangladesh +880
Barbados +1246
Barbuda +1268
Belarus +375
Belgium +32
Belize +501
Benin +229
Bermuda +1441
Bhutan +975
Bolivia +591
Bosnia & Herzegovina +387
Botswana +267
Brazil +55
British Virgin Islands
+1284
Brunei Darussalam +673
Bulgaria +359
Burkina Faso +226
Burundi +257
Cambodia +855
Cameroon +237
Canada +1
Cape Verde Islands +238
Cayman Islands +1345
Central African Republic
+236
Chad +235
Chatham Island(NZ) +64
Chile +56
China +86
Christmas Island +618
Cocos Keeling Islands +61
Colombia +57
Comoros +269
Congo +242
Congo(DR) +243
Cook Islands +682
Costa Rica +506
Côte d'Ivoire +225
Croatia +385
Cuba +53
Cuba (Guantanamo Bay) +5399
Curaçao +599
Cyprus +357
Czech Republic +420
Denmark +45
Diego Garcia +246
Djibouti +253
Dominica +1767
Dominican Republic +809
East Timor +670
Easter Island +56
Ecuador +593
Egypt +20
El Salvador +503
Ellipso +8812
Ellipso +8813
EMSAT +88213
Equatorial Guinea +240
Eritrea +291
Estonia +372
Ethiopia +251
Falkland Islands +500
Faroe Islands +298
Fiji Islands +679
Finland +358
France +33
French Antilles +596
French Guiana +594
French Polynesia +689
Gabonese Republic +241
Gambia +220
Georgia +995
Germany +49
Ghana +233
Gibraltar +350
Globalstar +8818
Globalstar +8819
Greece +30
Greenland +299
Grenada +1473
Guadeloupe +590
Guam +1671
Guantanamo Bay +5399
Guatemala +502
Guinea Bissau +245
Guinea +224
Guyana +592
Haiti +509
Honduras +504
Hong Kong +852
Hungary +36
ICO Global +8810
ICO Global +8811
Iceland +354
India +91
Indonesia +62
Inmarsat(Atlantic Ocean
E) +871
Inmarsat(Atlantic Ocean
W) +874
Inmarsat(Indian Ocean) +873
Inmarsat(Pacific Ocean)
+872
Inmarsat SNAC +870
Iran +98
Iraq +964
Ireland +353
Iridium +8816
Iridium +8817
Israel +972
Italy +39
Jamaica +1876
Japan +81
Jordan +962
Kazakhstan +7
Kenya +254
Kiribati +686
Korea (North) +850
Korea (South) +82
Kuwait +965
Kyrgyz Republic +996
Laos +856
Latvia +371
Lebanon +961
Lesotho +266
Liberia +231
Libya +218
Liechtenstein +423
Lithuania +370
Luxembourg +352
Macao +853
Macedonia(FYR) +389
Madagascar +261
Malawi +265
Malaysia +60
Maldives +960
Mali Republic +223
Malta +356
Marshall Islands +692
Martinique +596
Mauritania +222
Mauritius +230
Mayotte Island +269
Mexico +52
Micronesia +691
Midway Island +1808
Moldova +373
Monaco +377
Mongolia +976
Montenegro +382
Montserrat +1664
Morocco +212
Mozambique +258
Myanmar +95
Namibia +264
Nauru +674
Nepal +977
Netherlands +31
Netherlands Antilles +599
Nevis +1869
New Caledonia +687
New Zealand +64
Nicaragua +505
Niger +227
Nigeria +234
Niue +683
Norfolk Island +672
SaipanRota& Tinian
+1670
Norway +47
Oman +968
Pakistan +92
Palau +680
Palestinian Settlements
+970
Panama +507
Papua New Guinea +675
Paraguay +595
Peru +51
Philippines +63
Poland +48
Portugal +351
Puerto Rico +1787
Puerto Rico +1939
Qatar +974
Réunion Island +262
Romania +40
Russia +7
Rwandese Republic +250
St. Helena +290
St. Kitts/Nevis +1869
St. Lucia +1758
St. Pierre & Miquelon
+508
St. Vincent &
Grenadines +1784
Samoa +685
San Marino +378
São Tomé and
Principe +239
Saudi Arabia +966
Senegal +221
Serbia +381
Seychelles Republic +248
Sierra Leone +232
Singapore +65
Slovak Republic +421
Slovenia +386
Solomon Islands +677
Somali Democratic
Republic +252
South Africa +27
Spain +34
Sri Lanka +94
Sudan +249
Suriname +597
Swaziland +268
Sweden +46
Switzerland +41
Syria +963
Taiwan +886
Tajikistan +992
Tanzania +255
Thailand +66
Thuraya +88216
Timor Leste +670
Togolese Republic +228
Tokelau +690
Tonga Islands +676
Trinidad & Tobago +1868
Tunisia +216
Turkey +90
Turkmenistan +993
Turks and Caicos Islands
+1649
Tuvalu +668
Uganda +256
Ukraine +380
United Arab Emirates +971
United Kingdom +44
United States of America +1
US Virgin Islands +1340
UPT +878
Uruguay +598
Uzbekistan +998
Vanuatu +678
Vatican City +39
Venezuela +58
Vietnam +84
Wake Island +808
Wallis and Futuna Islands
+681
Yemen +967
Zambia +260
Zanzibar +255
Zimbabwe +263
Email Address: (Compulsory)
Yahoo, Msn, Skype, ICQ or GoogleTalk Messenger ID: [Compulsory if you use
- e.g Msn alvin@gmail.com ]
Yahoo
Msn
Skype
ICQ
GoogleTalk
NIL
Payment Method: (Compulsory)
Australia Internet Banking
Australia Cash Deposit (Post Office)
Australia Cash Deposit Bank Counter
China Internet Banking
China ATM Funds Transfer
China Cash Deposit Counter
China Cash Deposit Machine
India Cash Deposit Counter (Minimium 50 USD)
India Check Deposit (Available during Promotion only)
India Internet Banking (Available during Promotion only)
Malaysia Internet Banking
Malaysia ATM Funds Transfer
Malaysia Cash Deposit Machine
Malaysia Cash Deposit Counter
Philippines Cash Deposit Counter
Philippines ATM Funds Transfer (BancNet network only)
Singapore Internet Banking
Singapore ATM Funds Transfer
Singapore Cash Deposit Machine
Singapore Cash Deposit Counter
Thailand Internet Banking
Thailand ATM Funds Transfer
Thailand Cash Deposit Machine
Thailand Cash Deposit Counter
United States Cash Deposit Counter
Vietnam Internet Banking
Vietnam Cash Deposit Counter
MoneyGram
Western Union
Overseas Bank Wire (Telegraphic Transfer)
CitiBank Global Transfer
VISA Money Transfer (NOT payment by Debit/Credit Card)
Bank
Name & Bank's BSB / Account Number : [Compulsory if the order requires Bank account - e.g POSB,
MayBank, WestPac ]
DBS / POSB
OCBC
StanChart
HSBC
MetroBank
MayBank
CIMB Bank
RHB Bank
Bank of China
American Savings Bank
Bank of America
Bank of Hawaii
Chase Bank
CitiBank
U.S. Bancorp
Wells Fargo Bank
National Australia Bank
WestPac
Kasikorn Bank
AXIS Bank
HDFC Bank
ICICI Bank
State Bank of India
Vietcom Bank
Not Applicable
Others (Pls specify)
(Select Not Applicable
if not required a bank as the medium)
Information related to Buy Methods MoneyGram, Western Union, Bank Wire
or CitiBank Global Transfer only:
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