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PT INDO SEJAHTERA JAYA

FORMULIR PENDAFTARAN MEMBER MERCI


KANTOR / MASTER STOCKIS
Jl. Balai Desa Pasar 12 Marindal II Pondok Nusantara Blok F 26
Bp. Hidayat Marpaung – Sulastri. HP. 085270913789 / 081396470086
www.merci2u.id

1. Silver (1.2000.000) 3. Gold (3.600.000) 7. Platinum (8.400.000)


DATA SPONSOR DAN UP LINE
ID Sponsor : ……………………………………………………………………………………………………………
Nama Sponsor : ……………………………………………………………………………………………………………
ID Up Line : ……………………………………………………………………………………………………………
Nama Upline : ……………………………………………………………………………………………………………
Posisi : Kiri Kanan

DATA MEMBER
Nama yg Dipilih : ……………………………………………………………………………………………………………
Nama Lengkap : ……………………………………………………………………………………………………………
No. KTP : ……………………………………………………………………………………………………………
Tgl. Lahir : ……………………………………………………………………………………………………………
Alamat : ……………………………………………………………………………………………………………
Kota : ……………………………………………………………………………………………………………
Provinsi : ……………………………………………………………………………………………………………
Negara : ……………………………………………………………………………………………………………
No. HP : ……………………………………………………………………………………………………………
Nama Ibu Kandung : ……………………………………………………………………………………………………………
Ahli Waris : ……………………………………………………………………………………………………………
Email : ……………………………………………………………………………………………………………
NPWP : ……………………………………………………………………………………………………………

DATA BANK
Bank : ……………………………………………………………………………………………………………
Cabang : ……………………………………………………………………………………………………………
No. Rek : ……………………………………………………………………………………………………………
Atas Nama : ……………………………………………………………………………………………………………
Administrasi : Rp. 100.000,- (Tas, flipchart, browsur dan web pribadi)
MEMBANGUN EKONOMI RAKYAT CINTA INDONESIA
Hari___________ Tgl. ____ / ___ / _______
Leader merci hormat kami
Member baru

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