Welcome
Homepage
This is
About Us
Support
Contact Us
Hot Line
Contact on Facebook
Contact on Twitter
Catalogue
By Brand
Kayra
Premium
Calosa
Category
Busana Muslim
Kerudung
Promo
Big Sale
How To Order
Hijab Style
AGEN/RESELLER
Supplier Busana Muslim
Order Form
Payment Confirmation
skip to main
|
skip to sidebar
Customer Service :
Butiq2@yahoo.com/SMS 085722392000
|
Cspremium@yahoo.com/PIN BB 26A2E04B
Assalamuallaikum Warrahmatullahi Wabarakatuh
Welcome to
KAYRA MOSLEM
Dapatkan Discount khusus dengan menjadi member
Dan Discount Khusus untuk Reseler/Dropshipper
PAYMENT CONFIRMATION
PAYMENT CONFIRMATION
Name
*
First
Last
Email
*
Phone
*
Address
*
ZIP POSTAL
*
Amount Transferred/Jumlah Transfer
*
Bank Account Holder/ Rekening atas nama
*
If Different with Customer(Jika menggunakan rekening orang lain)
Date of Transfer
1
2
3
4
5
6
7
8
9
10
11
12
MM
/
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
DD
/
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
YYYY
Transfer To
*
BCA
MANDIRI
Image Verification
Please enter the text from the image
:
[
Refresh Image
] [
What's This?
]
Powered by
EMF
Web Forms Builder
Report Abuse
Comments
0 Comments
0 comments :
Post a Comment
Home
Subscribe to:
Posts ( Atom )
Tags :
BUSANA MUSLIM
|
BUSANA MUSLIM BRANDED
|
HIJAB STYLE
Copyright © 2012.
Supplier Busana Muslim
- All Rights Reserved
Last Modified by :
Tukang Toko Online