匯款資料單-499一日遊體驗行程7/24

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報名梯次 *

7/24行程A農事體驗

7/24行程B文化探訪

匯款人姓名 *

若報名繳費2人以上，僅需填寫一次匯款人資料即可，也麻煩在備註欄留下其他團員姓名。

匯款帳號後五碼 *

若臨櫃繳款請填寫臨櫃繳款

匯款日期 *

西元yyyy/mm/dd

匯款金額 *

2人以上成行團員請自行計算匯款總額

聯絡電話 *

請留手機電話為主，若無請留室內電話

備註

1.請留下同行家人/團員姓名，或特殊要求；若無，保持空白即可。2.若報名成員有年齡五歲以下孩童，也請於此藍未註明。

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