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dina's posts with tag: order form

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ORDER Form

May 15, '08 10:26 PM
for everyone

READ IT FIRST

Terms and Condition :
1. Pemesanan dilakukan dengan mengisi form dibawah ini dan segera menghubungi dina : +6281 327 312 711 untuk konfirmasi
2. Transfer via :
    =====================================
    Mandiri : IMAM SUPRIYADI a/c 139-00-0403220-1
    BNI      : DINA MARYATI a/c 0111379435
    =====================================
3. Setelah konfirmasi rekening, kami akan segera mengirimkan pesanan Anda. Pengiriman menggunakan TIKI, ELTEHA, atau POS (disesuaikan dengan permintaan customer). Terima kasih atas kunjungan Anda.
                                                                                                                                                                          Glitter Words

I Accepted the terms and conditions :	Yes No
Name:
Multiply ID
Email Address:
Address (Full Address)
City
Postal Code
Phone Number (home or mobile)
Payment Method
Product Code (Code and their Quantity)
Additional comment^_^

create form

Tags: order form

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dina's posts with tag: order form