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Formulir Pembelian Barang / Form Order
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* Indicates required question
Nama Pemesan / Name:
*
Isilah dengan nama lengkap sesuai KTP
Your answer
Contact Number:
*
Isilah dengan nomor telepon atau Hp
Your answer
Alamet e-mail:
*
Isilah dengan alamat e-mail (@gmail atau yahoo)
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Payment Method:
*
Metode Pembayaran yang dapat anda pilih
Transfer via BPD
Transfer via BRI
Transfer via Mandiri
Transfer via BCA
Western Union
Required
Pilih Barang / Choose shop:
*
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Mobile
Televisi
Parfum
Sepatu
Baju
Celana
Topi
Jam Tangan
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Kode Barang:
*
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Pilih Barang / Choose shop:
1
2
3
4
5
Mobile
Televisi
Parfum
Sepatu
Baju
Celana
Topi
Jam Tangan
Other
1
2
3
4
5
Mobile
Televisi
Parfum
Sepatu
Baju
Celana
Topi
Jam Tangan
Other
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