FORMULIR
PERMOHONAN ANGGOTA BARU
THE DUCK COMMUNITY (TDC)
= DATA PEMOHON =
Nama : ...........................................................................................................................
PIN : ............................................................................................
(diisi oleh Sponsor).
No. KTP. : ...........................................................................................................................
Tgl. lahir : ..........................................................................................................................
Alamat : ..........................................................................................................................
..........................................................................................................................
..........................................................................................................................
Kota / Kab : ..........................................................................
Kode Pos : .............................
Propinsi : ..........................................................................................................................
Negara : ..........................................................................................................................
No. HP : 62.....-.................................................................................................................
E-mail : ...................................................................
@...................................................
Data Rekening (Nama
Pemilik Rekening, harus sama dengan nama Pemohon).
Nama Bank : ..........................................................................................................................
Cabang : ..........................................................................................................................
Atas nama : ...........................................................................................................................
No. Rek : ..........................................................................................................................
Kota..................,.....................................
2015
Sponsor Pemohon
................................................ ................................................
ID.
Kirimkan
data anda ke alamat email : egendbiz.tdc@gmail.com atau ke
blogspot.tdc@gmail.com dan kirim SMS konfirmasi ke Admin dengan format :
REG_FRANCHISE_SATU_JUTA#Nama#Email.
Dan
kirimkan biaya pendaftaran sebesar Rp.1,000,XXX (tiga angka terakhir no.
hape anda) dikirim ke Rekening Bank Danamon Sariyah Yogyakarta,
Norek Norek.0035-8051-2204 an. Eko Gendroyanto.
