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BEG 4輯應援團購 匯款確認單
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* Indicates required question
姓名
*
Your answer
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)
Your answer
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)
Your answer
Email (若無上述兩個社團的帳號，請務必填寫有效mail!!!!!!)
*
Your answer
手機
*
Your answer
訂購數量
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1
2
3
Other:
銀行(郵局)代號
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使用無摺此欄填"無摺"
Your answer
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)
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Your answer
匯款總金額
*
Your answer
CD匯款金額
*
一張NTD450
兩張NTD830
三張NTD1210
四張NTD1590
五張NTD1970
Other:
應援金(有多匯應援金的親，請填應援金額)
*
無
Other:
7-11取貨地址(查詢店號、店名、地址，請到7-11網站查詢) 外島請用全家便利商店
*
請附上7-11的店號、店名、地址(請務必三樣都填寫!!! 請依照範例!!!例：店號：12345 店名：亞當門市 地址：亞當市亞當路520號)
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