Coupon Acknowledgement Form Thank you for your business with Pan Asian. Please submit the form below to claim your coupon. 感謝您與宏亞合作。請提交以下表格以領取您的現金卷。 Your Name 你的姓名(Required) Company Name 公司名稱(Required) Contact No. 聯絡電話Total Coupon Amount(HKD) 現金卷面值 (港元)(Required)Coupon Number 現金卷號碼(Required) Confirmation 確認(Required) Confirmation 確認(Required)I confirm receipt of the above supermarket coupon and agree to the terms and conditions related to its use. 本人確認已領取上述現金券,並同意其相關使用條款及細則。Signature 簽名(Required) Reset signature Signature locked. Reset to sign again