Formulir Pemesanan Rogo Transport Rental Motor
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Nama : *
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Alamat Rumah : *
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No KTP : *
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No WhatsApp :
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No Hp 1 : *
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No Hp 2 : *
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Pin BBM :
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Email :
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Facebook :
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Line :
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Pekerjaan : *
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Alamat Kantor : *
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Jaminan (Minimal 3 ) : *
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Tanggal dan Jam Mulai Sewa : *
Bulan-Hari-Thn Jam:Menit Misal : 02-30-2016 07:30
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Alamat Pengantaran Sepeda Motor : *
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Rencana sewa sampai dengan : *
Bulan-Hari-Thn Jam:Menit Misal : 02-30-2016 07:30
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Alamat Penjemputan Sepeda Motor Setelah Sewa : *
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Merk Sepeda Motor :
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Jumlah Sepeda Motor :
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Jumlah Helm :
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Sewa Accesories Lainnya :
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