Formulir Pendaftaran Merchant Cyberfood
Nama Merchant *
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Website Merchant
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Deskripsi Menu Merchant
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Alamat Lengkap Merchant *
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Kota *
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Provinsi *
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Nama Pemilik / PIC *
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No. Telepon Pemilik / PIC *
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Alamat Email *
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No. KTP Pemilik / PIC *
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Alamat Pemilik / PIC
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