Residential

Full Name as per Mykad*

Mobile Number for Calls*

Email*

Identification Card/Mykad Number*

For company representative / Claims

Company Registration Number

On-Site / Collection Address*






Person In-Charge/Representative Name*

Contact No. Person In-Charge/Representative*

Relationship*

State your availability* ---Mon-Fri Only (Daylight)Weekend Only (Daylight)Always (24/7)
Have you READ all the TERMS AND CONDITIONS ABOVE?* ---YesNo
Would you like to make the Upfront Payment RM50 for CONFIRMATIONS?* ---YesNo
State how many device/s that you require for Bootjunk for inspections?

*Please UPLOAD of the following documents:-
1. Picture of Mykad (crossmarked)*

2. Receipt of Upfront payment*

How long you require us to response to you?*
---2 weeks1 week24hours

I hereby declare by awareness without marking the Acceptance box digitally I am unable to apply the Appointment Basis or On-Site services forms and that all the information given above are correct for applying services with Jmaya Solutions Sdn Bhd (1361457-V) under Bootjunk license.If any of these terms is held to be invalid,illegal or unenforceable under any applicable law or court of law or by any reasons whatsoever,the legality and enforceability of the remaining provisions shall not be effected or impaired and in any way and such invalid,illegal or unenforceable provision shall be deemed deleted.Any upfront payment that had been made is not refundable due to cancellation without written notice.