Selamat datang untuk anda yang ingin meraih SUKSES dalam bisnis pulsa DBS ( Duta Business School ). Dengan hanya Investasi Rp. 200.000 ( untuk 1 Hak usaha ) anda berkesempatan memperoleh kebebsan finansial seumur hidup dan bisa diwariskan. Kami mencari leader-leader seperti anda dari berbagai kota di seluruh Indonesia untuk menjadi pebisnis DBS Sukses. Berminat, silahkan isi formulir di bawah ini dengan lengkap sesuai KTP<form method="post" action="http://www.emailmeform.com/fid.php?formid=292044" enctype="multipart/form-data" accept-charset="UTF-8">
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 <td nowrap><font face="Verdana" size="2" color="#000000">Nama</font></td>
 <td><input type="text" name="FieldData0" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Alamat Email</font></td>
 <td><input type="text" name="FieldData1" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Jenis Kelamin</font></td>
 <td><input type=radio name="FieldData2" value="laki-laki " id="radio20"><font face="Verdana" size="2" color="#000000"><label for="radio20">laki-laki </label></font><br><input type=radio name="FieldData2" value=" Wanita" id="radio21"><font face="Verdana" size="2" color="#000000"><label for="radio21"> Wanita</label></font><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Tempat tanggal lahir</font></td>
 <td><input type="text" name="FieldData3" size="60"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Alamat</font></td>
 <td><textarea name="FieldData4" cols="60" rows="10"></textarea><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Kota</font></td>
 <td><input type="text" name="FieldData5" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Nomor HP</font></td>
 <td><input type="text" name="FieldData6" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Bank</font></td>
 <td><input type=radio name="FieldData7" value="BCA " id="radio70"><font face="Verdana" size="2" color="#000000"><label for="radio70">BCA </label></font><br><input type=radio name="FieldData7" value=" BNI " id="radio71"><font face="Verdana" size="2" color="#000000"><label for="radio71"> BNI </label></font><br><input type=radio name="FieldData7" value=" MANDIRI" id="radio72"><font face="Verdana" size="2" color="#000000"><label for="radio72"> MANDIRI</label></font><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Nomor Rekening</font></td>
 <td><input type="text" name="FieldData8" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Atas Nama</font></td>
 <td><input type="text" name="FieldData9" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Nama Ibu Kandung</font></td>
 <td><input type="text" name="FieldData10" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Ahli Waris</font></td>
 <td><input type="text" name="FieldData11" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Nama Ahli Waris</font></td>
 <td><input type="text" name="FieldData12" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Pesan</font></td>
 <td><input type="text" name="FieldData13" size="30"> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Tahu DBS dari Mana?</font></td>
 <td><input type=radio name="FieldData14" value="google.com " id="radio140"><font face="Verdana" size="2" color="#000000"><label for="radio140">google.com </label></font><br><input type=radio name="FieldData14" value=" yahoo.com " id="radio141"><font face="Verdana" size="2" color="#000000"><label for="radio141"> yahoo.com </label></font><br><input type=radio name="FieldData14" value=" Teman " id="radio142"><font face="Verdana" size="2" color="#000000"><label for="radio142"> Teman </label></font><br><input type=radio name="FieldData14" value=" Penawaran via email " id="radio143"><font face="Verdana" size="2" color="#000000"><label for="radio143"> Penawaran via email </label></font><br><input type=radio name="FieldData14" value=" Iklan Baris " id="radio144"><font face="Verdana" size="2" color="#000000"><label for="radio144"> Iklan Baris </label></font><br><input type=radio name="FieldData14" value=" Majalah " id="radio145"><font face="Verdana" size="2" color="#000000"><label for="radio145"> Majalah </label></font><br><input type=radio name="FieldData14" value=" surat kabar " id="radio146"><font face="Verdana" size="2" color="#000000"><label for="radio146"> surat kabar </label></font><br><input type=radio name="FieldData14" value=" Televisi " id="radio147"><font face="Verdana" size="2" color="#000000"><label for="radio147"> Televisi </label></font><br><input type=radio name="FieldData14" value=" dll" id="radio148"><font face="Verdana" size="2" color="#000000"><label for="radio148"> dll</label></font><br> </td>
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 <td nowrap><font face="Verdana" size="2" color="#000000">Rencana Gabung Berapa HU ( Hak Usaha ) ?</font></td>
 <td><input type=radio name="FieldData15" value="1 HU ( Hak Usaha ) Rp. 200.000,- " id="radio150"><font face="Verdana" size="2" color="#000000"><label for="radio150">1 HU ( Hak Usaha ) Rp. 200.000,- </label></font><br><input type=radio name="FieldData15" value=" 3 HU ( Hak Usaha ) Rp. 500.000,- " id="radio151"><font face="Verdana" size="2" color="#000000"><label for="radio151"> 3 HU ( Hak Usaha ) Rp. 500.000,- </label></font><br><input type=radio name="FieldData15" value=" 7 HU ( Hak Usaha ) 1.100.000,-" id="radio152"><font face="Verdana" size="2" color="#000000"><label for="radio152"> 7 HU ( Hak Usaha ) 1.100.000,-</label></font><br> </td>
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<td class="label" colspan="2"><font color="#FFFFFF" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<td class="captcha" style="padding: 2px;" width="10"><img src="http://www.emailmeform.com/turing.php" id="captcha" alt="captcha"></td>
<td class="field" valign="top"><div><font color="#000000">Please enter the text from the image</font>:<br><input type="text" name="Turing" value="" maxlength="100" size="10">
 [ <a href="#" onclick=" document.getElementById('captcha').src = document.getElementById('captcha').src + '?' + (new Date()).getMilliseconds()">Refresh Image</a> ] [ <a href="http://www.emailmeform.com/?v=turing&amp;pt=popup" onClick="window.open('http://www.emailmeform.com/?v=turing&amp;pt=popup','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a> ]</div>
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<input type="text" name="hida2" value="" maxlength="100" size="3" style="display : none;">
<input type="submit" class="btn" value="Send email" name="Submit">&nbsp; &nbsp; <input type="reset" class="btn" value="  Clear  " name="Clear"></td>
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</form>CATATAN :
Setelah anda mengisi formulir di atas silahkan transfer bea daftar sebesar Rp. 200.000 ( untuk 1 HU/Hak Usaha ) atau Rp. 500.000 ( 3 HU/Hak Usaha ) atau Rp. 1.100.000 ( 7 HU/Hak Usaha ) ke bank BNI No rek.0140476603 atau BCA No rek. 0510621859 atas nama MUKTI EFFENDI. Setelah transfer tolong kirim sms Konfirmasi ke 085651365539 dengan format : terserah anda yang penting jelas. Setelah transfer anda valid maka segera akan kami proses keanggotaan anda di DBS.  Untuk lebih detail tentang DBS silahkan kontak saya 085651365539