應援金及海報筒補匯確認單
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姓名 *
亞當夫婦台灣首站帳號(若沒有首站帳號請填下面FB亞當社團帳號)
FB亞當社團Email帳號(Adam.TW)
請填寫你登入FB的email帳號喔!!!!!!!不是你FB的暱稱，千萬不要弄錯了喔!!!!!!(請寫完整mail地址)
Email *
手機 *
銀行(郵局)代碼 *
匯款帳號後七碼，請將號碼括號起來 EX：(1234567) 使用無褶請填局號後七碼，並在後面加上無褶 ex. (1234567無褶) *
應援金金額(扣掉海報桶20元) *
補匯20塊海報桶 *
Required
總共匯款金額 *
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