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FORMULIR PENDAFTARAN BERGABUNG KE PT BBC

DATA PRIBADI

1. Nama : .......................................................................
2. No. WA : .......................................................................
3. Gmail : .......................................................................
4. Alamat lengkap : .......................................................................
5. Kelurahan : .......................................................................
6. Kecamatan : .......................................................................
7. Provinsi : .......................................................................
DATA BANK

a. Nama Bank : .......................................................................

b. No. Rekening : .......................................................................

c. Nama Pemilik : .......................................................................

(Member Ship Join Modal Join)

Pilihan

1. Emerald Rp. 625.000 ( 1 Poin)

2. Silver Rp. 1.250.000 (2 Poin)

3. Gold Rp. 3.750.000 (6 Poin)

4. Diamon Rp. 8.750.000 (14 Poin)

*Coret yang tidak perlu

(Yang Mengundang) Sponsor = A. TOLIB

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