FORM REGISTRASI E-MIRACLE

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FORM REGISTRASI E-MIRACLE

Isi formulir pendaftaran dibawah ini dengan benar dan lengkap, terutama No. HP, Email dan No. Rekening.

• Nama Lengkap *
  First Last
• Email *
• No.Tlp / HP *
• Alamat
  Street Address City State / Province / Region Postal / Zip Code  Antigua and BarbudaArubaBahamasBarbadosBelizeCanadaCayman IslandsCook IslandsCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNetherlands AntillesNicaraguaPanama Puerto Rico Saint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColombiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFaroe IslandsFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyKosovoLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorHong KongIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPalestinePhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosDemocratic Republic of the CongoRepublic of the CongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGibraltarGuineaGuinea-BissauCote d'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandUnited Republic of TanzaniaTogoTunisiaUgandaZambiaZimbabwe Country / Region
  
• No.Identitas (KTP/SIM) *
• PIlihan Paket *
  Silver Rp. 250.000Gold Rp. 500.000Platinum Rp. 1.500.000
  

  Jika pilihan paket Silver Rp.250.000, maka lakukan Transfer dana Tambahkan 4 Digit Angka terakhir No.HP Anda ,contoh : No. HP 0853-4213-0123
  Nilai Transfer Rp.250.000+0123 = Rp. 250.123 (paket Silver) dan paket besar lainnya..
  
  TRANSFER SESUAIKAN ZONA PENDAFTAR/PEMESAN
  
  Hak Usaha e-Miracle ASLI + ongkir.
  transfer sebesar sebagai berikut (sudah termasuk ongkir)
  
  Zona 1 JAWA - BALI
  PLATINUM : Rp. 1.590.000
  GOLD : Rp. 580.000
  SILVER : Rp. 295.000
  
  Zona 2 = Sumatera - NTB
  PLATINUM : Rp. 1.595.000
  GOLD : Rp. 590.000
  SILVER : Rp. 300.000
  
  Zona 3 = Kalimantan - Sulawesi -NTT-Aceh
  PLATINUM : Rp. 1.615.000
  GOLD : Rp. 595.000
  SILVER : Rp. 315.000
  
  Zona 4 = Maluku - IrianJaya
  PLATINUM : Rp. 1.760.000
  GOLD : Rp. 640.000
  SILVER : Rp. 370.000
  
  
• Data Ahli Waris
• Nama Lengkap *
  First Last
• Hubungan
• No.telp / hp
• REKENING BANK UNTUK TRANSFER BONUS
• No.Rekening Bank *
• Nama Bank *
  BNIBCABRIMANDIRI
• Atas Nama *
  First Last
• catatan :
  transfer sesuai zona wilayah pendaftar dan sejumlah paket usaha yg di inginkan, ke no rekening BRI SYARIAH 1015094075 a/n FIKRI ISLAMI Wajib anda melakukan konfirmasi melalui
  
  FIKRI ISLAMI
  
  via
  
  HP. 085881110092/085883772424,
  BBM. 755A9FBA,
  WA. 085883772424,
  
  bukti struck transfer harap dilampirkan..
  
  jika anda telah melakukan pembayaran.
  
• 
  

  

  

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