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Payment Confirmation Form
Please confirm your payment by filling out this form. Thank ya mamas cantik.
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Reg Number (Invoice)*
The number of the invoice we sent (Nomer invoice yang kami kirim)
Your answer
Name*
Your answer
Bank Transferred*
Choose one (pilih salah satu)
BCA
BRI
Bank Account Name
Name of account holder (Nama pemilik rekening yang dipakai untuk transfer)
Your answer
Date of Payment*
Your answer
Amount of Payment
Your answer
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