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INFORMASI PENGIRIMAN
Informasi member untuk memudahkan pengiriman merchandise
* Indicates required question
Email
*
Your email
Nama
*
Your answer
USER ID
*
Your answer
Nama Akun FB yang dipakai untuk claim
*
Your answer
Email
*
Your answer
No rekening yang terdaftar
*
Your answer
Alamat Lengkap
*
Your answer
RT dan RW
*
Your answer
Nama Kelurahan
*
Your answer
Nama Kecamatan
*
Your answer
Kode pos
*
Your answer
Nomor telepon yang bisa dihubungi oleh kurir
*
Your answer
Pilihan hadiah
*
Choose
T-shirt L
T-shirt XL
Exclusive Zippo
T-shirt L + Exclusive Zippo
T-shirt XL + Exclusive Zippo
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