Please cancel my previous autobilling if I had
signed-up with other Banks:
Bank Acct No. :
ASTRO
A/C No:
CELCOM
A/C No:
Handphone No:
DiGi
A/C No:
Handphone No:
ELECTCOMS (Paging Service)
A/C No:
MAXIS
A/C No:
Handphone No:
MPAJ - MAJLIS PERBANDARAN AMPANG JAYA
Assestment Acct No.:
TIME (TT dotCom Sdn. Bhd.)
A/C No:
TIMENet (TIME dotNet Bhd.)
A/C No:
MAA ASSURANCE
Policy No:
Relationship to Cardholder:
Policy No:
Relationship to Cardholder:
* FREEDiners Club Travel Bag when you sign up for TWO(2) or service provider accounts. * The delivery of gift will require up to ten (10) weeks from the date of the first
successful transaction. * In the event that the gift is unavailable, Diners Club reserves the right to replace it with an item of similar value. Offer is valid till February 28, 2009.
* 2,000 Club Rewards Points will be credited into your Diners Club account if only ONE (1) service provider account is approved.
I enclose a copy of my latest paid Telekom / TNB / Celcom /
Astro / Electcoms / DiGi / TM Touch / Maxis / MPAJ / TIME /
TIMENet / MAA Assurance bills for your necessary action.
I undertake to pay all bills charged under the above stated
Automatic Bill Payment Service and be bound by the terms and
conditions of the Diners Club Card.
Signature:
Date:
Please fill, print and
send this form to:
Diners Club (Malaysia)
Sdn Bhd
15th Floor, Menara Tan & Tan, 207, Jalan Tun Razak
P.O Box 11095, 50990 Kuala Lumpur, Malaysia
or
Fax : 03-2161 2835
For more information, please call our Customer Services
Personnel at Tel : 03-2161 1055
For security purpose, please DO NOT send account or confidential
information via the Internet or e-mail as it will not
be encrypted during transmission.
