匯款回報表單系統
匯款回報表單系統(提醒)
--請留意:務必先匯款完成後才填寫表單
--系統收到您的填單後會計人員將於7天內簡訊通知您是否匯款完成
就診客戶姓名
Your answer
就診客戶生日(如:74/01/01或1985/01/01皆可)
Your answer
匯款人姓名(非就診客戶本人請務必填寫,本人匯款可免填)
Your answer
匯款日期
MM
/
DD
/
YYYY
匯款帳號後五碼或帳戶戶名(供工作人員查核用)
Your answer
匯款金額
Your answer
手機號碼(輸入格式如:0912-345678)
填單後會計人員將於7天內簡訊通知您是否匯款完成
Your answer
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