GLAMO HOUSING Registration Form
Text field in ( * ) are compulsory to fill in.
PROJECT *
Taman Seri Orkid - 2 1/2 Storey Terrace House
Anggerik Emas Industrial & Commercial Park - 2 Storey Shop Office
Taman Seri Orkid - Three Storey Shop Office
Skudai Showroom City
Anggerik Emas Industrial & Commercial Park - 2 Storey Semi-Detached Factory
Orchid View
ENQUIRER'S INFORMATION
Salutation *
:
Mr
Mrs
Ms
Name *
:
Company Name *
:
Nationality *
:
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
ASHMORE AND CARTIER ISLANDS
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BAKER ISLAND
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA-HERZEGOVINA
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 (DRC)
COOK ISLANDS
CORAL SEA 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
F.Y.R.O. MACEDONIA
FAEROE ISLANDS
FIJI ISLANDS
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN AND ANTARCTIC LANDS
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MCDONALD ISLANDS
HONDURAS
HONG KONG SAR
HOWLAND ISLAND
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JARVIS ISLAND
JERSEY
JOHNSTON ATOLL
JORDAN
KAZAKHSTAN
KENYA
KINGMAN REEF
KIRIBATI
KOREA (NORTH)
KOREA (REPUBLIC OF)
KUWAIT
KYRGYZSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU SAR
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MAN (ISLE OF)
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MIDWAY ISLANDS
MOLDOVA
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
OTHERS
PAKISTAN
PALAU
PALMYRA ATOLL
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN ISLAND
POLAND
PORTUGAL
PUERTO RICO
QATAR
RÉUNION
ROMANIA
RUSSIA
RWANDA
SAINT HELENA
SAINT PIERRE AND MIQUELON
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAK REPUBLIC
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
ST. KITTS AND NEVIS
ST. LUCIA
ST. VINCENT AND THE GRENADINES
SUDAN
SURINAM
SVALBARD AND JAN MAYEN ISLANDS
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES OF AMERICA
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIETNAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S.)
WAKE ISLAND
WALLIS AND FUTUNA
YEMEN
ZAMBIA
ZIMBABWE
Race *
:
Malay
Chinese
Indian
Others
Tel (H) *
:
Tel (Office) *
:
Tel (Mobile) *
:
Email *
:
Address *
:
City *
:
Postcode *
:
State *
:
Country *
:
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTIGUA AND BARBUDA
ARGENTINA
ARMENIA
ARUBA
ASHMORE AND CARTIER ISLANDS
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BAKER ISLAND
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA-HERZEGOVINA
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 (DRC)
COOK ISLANDS
CORAL SEA 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
F.Y.R.O. MACEDONIA
FAEROE ISLANDS
FIJI ISLANDS
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN AND ANTARCTIC LANDS
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD ISLAND AND MCDONALD ISLANDS
HONDURAS
HONG KONG SAR
HOWLAND ISLAND
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JARVIS ISLAND
JERSEY
JOHNSTON ATOLL
JORDAN
KAZAKHSTAN
KENYA
KINGMAN REEF
KIRIBATI
KOREA (NORTH)
KOREA (REPUBLIC OF)
KUWAIT
KYRGYZSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU SAR
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MAN (ISLE OF)
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
MAYOTTE
MEXICO
MICRONESIA (FEDERATED STATES OF)
MIDWAY ISLANDS
MOLDOVA
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
OTHERS
PAKISTAN
PALAU
PALMYRA ATOLL
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN ISLAND
POLAND
PORTUGAL
PUERTO RICO
QATAR
RÉUNION
ROMANIA
RUSSIA
RWANDA
SAINT HELENA
SAINT PIERRE AND MIQUELON
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA AND MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAK REPUBLIC
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS
SPAIN
SRI LANKA
ST. KITTS AND NEVIS
ST. LUCIA
ST. VINCENT AND THE GRENADINES
SUDAN
SURINAM
SVALBARD AND JAN MAYEN ISLANDS
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES OF AMERICA
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIETNAM
VIRGIN ISLANDS (BRITISH)
VIRGIN ISLANDS (U.S.)
WAKE ISLAND
WALLIS AND FUTUNA
YEMEN
ZAMBIA
ZIMBABWE
Occupation *
:
In what manner do you wish to receive updates from Glamo Housing?
Email
SMS
Mail
How did you know about us?
Newspaper
Internet/Website
Brochures/Flyers
Poster/Banners
Billboards
Through Friends / Relative / etc
Exhibition
Others
State your monthly household income *
Below RM 4,000
RM 8,001 - RM 10,000
RM 4,001 - RM 6,000
Above RM10,000
RM 6,001 - RM 8,000
Copyright 2011
Glamo Housing Sdn. Bhd.
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