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Field Name (Attribute) | Description | Examples |
Account* | Your ID Account | 000150 |
First Name* | Your first name | Muhammad |
Middle Name (Otional) | Middle name (if any) | Rafly |
Last Name* | Your Last name | Andrianza |
Date of Birth* | Your Real Date of Birth | 02 Aug 2001 |
Is Member? | is this customer member part of you? | Select / Deselect- Checklist |
(*)Required.
Customer Address :
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Field Name (Attribute) | Description | Examples |
Street* | Your Street Name | Srikaya Street 6 |
City* | Your City states | Jakarta Pusat |
Postal code (optional) | Postal ZIP Code (if any) | 102030 |
Country* | Your Real Country | Indonesia |
Region (optional) | Your Region States (if any) | DKI Jakarta |
Customer Contact :
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Field Name (Attribute) | Description | Examples |
Email (Optional) | Fill with your Email (if any) | |
Phone (Optional) | Fill with your Phone Number (if any) | (021) - 7994 - 372 |
Mobile (Optional) | Fill with your Mobile Number (if any) | +62 876 3829 3849 |
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