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Qnada stuff Payment Confirmation (konfirmasi pembayaran barang Qnada)
Please confirm your payment by filling out this form ^^
(Mohon melakukan konfirmasi pembayaran dengan mengisi kolom di bawah ini)
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* Indicates required question
NO. REG
*
(No. Reg yang tertera di email invoice yang diterima)
Your answer
NAME
*
Your Full Name (Nama lengkap Pemesan)
Your answer
BANK TRANSFERRED
*
Choose one (pilih salah satu)
MANDIRI
BNI
BCA
Other:
BANK ACCOUNT NAME
*
Name of account holder (Nama pemilik rekening yang digunakan untuk melakukan pembayaran)
Your answer
BANK ACCOUNT NUMBER
*
Your bank account number (Nomer rekening Bank yang dipakai untuk melakukan pembayaran)
Your answer
DATE OF PAYMENT *
*
(Tanggal Pembayaran)
Your answer
AMOUNT OF PAYMENT
*
Jumlah Pembayaran (ex : Rp 100.000)
Your answer
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