FORMULIR PEMESANAN

MO : No. :
SN : Tgl :

Nama Peusahaan : .......................................................................................................................................

Contact Person : .......................................................................................................................................
NPWP* : .......................................................................................................................................
Alamat sesuai NPWP* : .......................................................................................................................................
.......................................................................................................................................
Alamat Kantor** : .......................................................................................................................................
.......................................................................................................................................
Telepon : .............................. ext : .................................. Fax. : ..................................
HP : ..............................
E-Mail : ..............................
Alamat Rumah : .......................................................................................................................................
......................................................................................... Kode Pos : .............................
Telepon Rumah : ......................................................................................... Fax. : ....................................

Cat : * Diisi jika menginginkan Faktur Pajak, dilampiri dengan foto copy Kartu NPWP dan/atau Surat Keterangan Terdaftar
** Diisi jika alamat kantor tidak sama dengan alamat yang terdaftar di NPWP

Produk yang dipesan :

Produk Harga/Unit Unit Jumlah

Akselerasi PPh21 (Default 100 karyawan) Rp 7.000.000,-
Tambah NPWP Khusus Cabang (Default 50 karyawan) Rp 500.000,-
Tambah NPWP (Default 50 karyawan) Rp 1.500.000,-
Maintenance – 1 Tahun Rp 1.500.000,-
Additional User Rp 250.000,-
Additional Karyawan (per 100 karyawan)
Rp 500.000,-

Biaya Add On
RP 2.500.000,-

Sub Total
PPN 11%
Total
Harga belum termasuk PPN

Cara Pembayaran : Alamat Pengiriman :

Transfer ke rekening BCA cabang Cyber II Rumah

No. Rek. 607-029-888-9 a/n PT. Integral Data Prima Kantor
Transfer ke rekening Mandiri cabang Rawamangun Pegambiran Lain......................................................................
No. Rek. 006-00-0766618-7 a/n PT. Integral Data Prima ............................................................................
Telp.

......................., ............................

( _____________________________ )

Catatan :
 Apabila pembayaran telah dilakukan, mohon dapat mengirimkan bukti/dokumen pembayaran
via email : sales@ortax.org
 Pembelian Software tidak dikenakan PPh kecuali untuk biaya maintenance tahunan.