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Identitas dan Nama Bank
No. KTP/NIK
*
Nama Bank
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No. Rek
*
Atas Nama
*
Ahli Waris
*
Pembayaran Pendaftaran
Paket Keanggotaan
*
Rp. 250.000
Rp. 1.250.000
Rp. 3.000.000
Rp. 4.500.000
Jumlah yang ditransfer sama dengan jenis keanggotaan yang dipilih
No. Rek
isi jika transfer lewat ATM
Tanggal & Waktu Tansfer
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PM
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Berita
Jenis Produk
Pilih produk yang akan dipesan, bisa 1 jenis atau multi
Gorgeous Milk Powder
1
2
3
4
5
6
7
8
9
10
15
20
Gorgeous White Tea
1
2
3
4
5
6
7
8
9
10
15
20
Gorgeous Black Tea
1
2
3
4
5
6
7
8
9
10
15
20
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