Easy Payment Application Form / Pre-Approval

We will contact you immediately upon receiving your application form

AEON-XPRESS Easy Payment Information

Please choose one to progress application form

Applicant Information
Mr.    Mrs.    Ms.
Full Name As In I.C.
New I.C. No. Use Format : xxxxxx-xx-xxxx
Old I.C. No.
Present Residential Address
Postcode :    State :
House Telephone No.
-
Handphone No.
-
Own Property
Parent's Property
Relative's Property
Renting With Family
Renting With Friends
Company's Quarter		 No. of Occupants
Years of Stay
Years

Months
Application Date
Licence
(B/B2)
Date Of Birth
Sex
Male Female
Race
Malay Chinese Indian Others
Marital Stutus
Married Single
   
Email Address Use Format : xxx@abc.com
Name of Company
Office Address
Postcode :    State :
Office Telephone No.
- (Ext )
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.
-
Office Telephone No.
- (Ext )

Motorcycles Order Information
Motorcycles Model
Installment Period
Installment Plan

Agreed
*** I agree to accept by the "Terms & Conditions" of the agreement.
* We reserves the right to reject this application without giving any explanation and documents submited for this application will not be returned.
* Terms and conditions apply.