Receipt Submission Form

Family Store Melaka > Receipt Submission Form

Contact Form Demo

Full Name

Phone Number

Email (Optional)

Identification Number (IC)

Address

Receipt Date (Draw Period : 31/07 - 31/08)

Receipt Number / Invoice No.

Total Purchase Amount (Min RM100)

Select Outlet Location

Receipt Image Upload

Upload or take a photo of your receipt

Checkbox Field

I agree to the collection and use of my personal data by Family Store Melaka for verification and promotional purposes, in accordance with the Personal Data Protection Act 2010 (PDPA).