MOLADIN - Always on Sept 2025 Mitra EV Blindvan

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Date *

YYYY

Name *

Gender

Male

Female

Clear selection

Phone Number *

Email *

City *

Dealer *

Product *

Payment Type *

Cash

Credit

Plan To Buy *

0-1 Months

1-3 Months

>3 Months

Occupation *

Test Drive *

Yes

Test Drive Message

(Optional)

Test Drive Location

Address / location to test drive, depends on the program can be on certain address of certain Wuling Dealer (Optional)

Car Owner
*

Do the lead has car at the moment?

Yes

Price Offering *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Moladin.

Does this form look suspicious? Report