FORMULIR MITRA HOPE RUMAH IMPIAN
Jenis Mitra Hope:
1. Mitra Hope (MH) 100 K - Donasi bulanan sebesar Rp 100.000
2. Mitra Hope (MH) Prima - Donasi bulanan sebesar Rp 500.000
3. Mitra Hope (MH) Ultima - Donasi bulanan sebesar Rp 1.000.000 atau lebih
Terimakasih atas kesediaan Bapak/Ibu/Saudara berkomitmen menjadi Mitra Hope Yayasan Rumah Impian. Semoga Tuhan membalas kebaikan Bapak/Ibu/Saudara.
Kontak kami di
Email :
lsm.rumah.impian@gmail.com
WA : 081298400428 Telegram: 081236055759
* Required
Nama Lengkap (full name)
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Your answer
Alamat (address)
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Your answer
Email
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Your answer
Telepon (phone number)
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Your answer
Pekerjaan (Occupation)
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Your answer
Berkomitmen menjadi Mitra Hope (agree to join Mitra Hope)...
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100K
Prima
Ultima
Required
Berkomitmen selama (duration of commitment)
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6 bulan
1 tahun
Required
Donasi ditransfer ke rekening (Donation will be transfered to)...
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Bank Mandiri KCP UNY 137-00-1114033-8 a.n. Yayasan Rumah Impian
Bank BCA 0372963199 a.n. Dyah Kusuma Herjanti
Required
Bersedia dihubungi untuk program Yayasan Rumah Impian yang lain (Agree to receive information about our programs)
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via Post (mail)
via Email
via telepon/SMS/WhatsApp/Telegram
Tanggal pertama kali transfer (date of the first transfer)
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Your answer
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