Form Pendaftaran

JAVA TRAVEL INDONESIA
Kantor Operasional:
Ged. Wisma KDS Lt.2 Ruang 204,
Jl. Mampang Prapatan No.6B
Jakarta Selatan, 12740.
Email : [email protected]
No. Telp : 021-22790628
FORMULIR PENDAFTARAN AGEN / DISTRIBUTOR
Nama Lengkap
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No Handphone / WA
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TTL
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Alamat Lengkap
Jalan
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RT/RW
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Kelurahan
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Kecamatan
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Kabupaten/Kota
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Provinsi
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Kode Pos
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Email
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Status Lisensi
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Nama Travel
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User ID Mentor
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Pembayaran melalui
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Jumlah pembayaran
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No. Rekening Java Travel : Bank Mandiri 1250012636817 an PT Citra Travelindo Jaya.
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