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Formulir Pembelian Barang / Form Order
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Nama Pemesan / Name
*
Nomer Telepon / Handphone
*
Alamat Pengiriman
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Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
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
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Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
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Bolivia
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Denmark
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Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
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Kosovo
Latvia
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Yemen
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Marshall Islands
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Tonga
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Algeria
Angola
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Republic of the Congo
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Libya
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Nigeria
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Zimbabwe
Country / Region
E-mail
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Pilihan Barang / Choose Shop
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Koko
Gamis
Mukena
Ukuran : M / L / X
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M
L
X
Jumlah Pesanan :
Order (Nama Produk, Ukuran, dan Jumlahnya)
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Payment Method :
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Western Union
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