Order

---

* Wajib

Nama pemesan / Name : *

Contact Number *

Alamet e-mail *

Pilih Barang / Choose shop * Party Shoes Wedding dress Travel Bag T-shirt Formal Clothes Sport t-shirt Pijama Blouse dress

Payment Method *

• Transfer Via BCA
• Transfer VIA Bank Mandiri
• Transfer Via BRI
• Western Union

Jumlah Pemesanan *

		1	2	3	4	5
Wedding Dress
Party Shoes
Travel Bag
T-shirt
Sport T-short

Jangan pernah mengirimkan sandi melalui Google Formulir.

Diberdayakan oleh Google Docs Laporkan Penyalahgunaan - Persyaratan Layanan - Ketentuan Tambahan