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Kiss'U Shop
CONFIRMATION OF PAYMENT
Name :
*
First
Last
Email :
*
No. Customer:
*
Payment via :
*
-choose one-
ATM BNI
ATM MANDIRI
cash deposit
ATM BERSAMA/OTHER BANK
PAYPAL
payments on behalf of :
*
Total Payment :
*
Date of Payment
*
MM
/
DD
/
YYYY
proof of payment
*
(upload the SCAN / PHOTO proof of payment with the clear)
To Purchase
*
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