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FORM PENDAFTARAN PPOB SMS
Bila dalam 1x24 jam tidak ada SMS pemberitahuan/ mengalami kendala dalam pengisian formulir, harap hubungi customer service via YM
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* Indicates required question
JENIS PPOB
*
Berikan tanda centang
PPOB SMS
Required
NAMA
*
isi nama lengkap
Your answer
NO HP
*
isi no HP transaksi
Your answer
KODE POS
*
Your answer
DESA
*
Your answer
KECAMATAN
*
Your answer
KABUPATEN
*
Your answer
PROVINSI
*
Your answer
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