保康生醫客戶需求表單

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保康生醫客戶需求表單

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保康生醫很高興為您服務！填寫表單的夥伴~我們會優先跟您聯繫唷 ！

一. 基本資料

1. 公司抬頭 *

若青創或小農可寫團隊名或個人名

Your answer

2. 統編

若青創或小農無統編可寫無

Your answer

3. 地址 *

樣品寄送用

Your answer

4. 聯絡人
*

Your answer

5. 電話
*

Your answer

6. LINE ID
*

Your answer

7. What's app ID

Your answer

8. 微信 WeChat ID

Your answer

9. E-mail
*

Your answer

10. 方便聯絡時間*
*

上午 08:00~12:00

下午 13:00~18:00

晚上 18:00~22:00

Other:

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