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KONFIRMASI TRANSAKSI JASA ORDER S.O.S
Mohon form diisi dengan benar & lengkap, kami tidak bertanggung jawab jika data yang diinput tidak sesuai keterangan sebenarnya !
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Setelah data disubmit segera konfirmasi by sms ke nmr HP kami untuk segera diproses !
===> Saya sudah mentransfer dana untuk transaksi dengan data sbb :
TGL TRANSFER
DD
/
MM
/
YYYY
DARI REK ATAS NAMA
JML TRANSFER
Rp
rupiah
.
Sen
VIA BANK
BCA
MANDIRI
BNI
BRI
BUKTI TRFER
_____________________________________________________________
NAMA BARANG
JUMLAH (Quantity)
TYPE / WARNA BARANG
BRG DIKIRIM KPD
(Nama Jelas Sesuai Identitas )
NO HP
Email
ALAMAT KIRIM
Street Address
Alamat Baris 2
kota
Negara Bagian / Provinsi / Wilayah
Pos / Kode Pos
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
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Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
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Luxembourg
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Netherlands
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Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
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China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
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Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
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Uzbekistan
Vietnam
Yemen
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Kiribati
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Nauru
New Zealand
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Papua New Guinea
Samoa
Solomon Islands
Tonga
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Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
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Chad
Comoros
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Republic of the Congo
Djibouti
Egypt
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Eritrea
Ethiopia
Gabon
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Guinea
Guinea-Bissau
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Kenya
Lesotho
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Libya
Madagascar
Malawi
Mali
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Mauritius
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Niger
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South Africa
Sudan
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United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
negara
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