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Propcon Payment Confirmation

1. Personal Data.
2. First Name(*)
   Please type your first name
3. Last Name
   Please type your last name
4. Telephone(*)
   Please type your telephone number
5. Mobile Phone(*)
   Please type your mobile phone number
6. E-mail(*)
   Invalid email address.
7. Address(*)
   Please type your address
8. PAYMENT INFO
9. For Payment(*)
   Annual Membership

   Sponsorship

   OthersPlease specify your purpose of payment
10. Your Account Name(*)
    Please type your account Name holder
11. Your Account Number(*)
    Please type your account Number
12. Your Bank Name(*)
    Please type your Bank Name
13. Date of Payment(*)
    Please type your Date of Payment
      Please click the pop up calendar
14. Date of Submission(*)
    Please type your date of submission
      Please click the pop up calendar
15. Methode of Payment(*)
    Cash / Inhouse transfer to PROPCON BCA Account

    Domestic transfer from other bank to PROPCON BCA Account

    International transfer from to PROPCON BCA AccountPlease specify your methode of payment
16. Upload your scan of transfer payment
    Invalid Input
17. Or fill in your Transfer Note
    Please type your address
18.   
19. PROPCON GOLF CLUB,
    Bank BCA, KCP Suryopranoto, Jakarta,
    Acc # 261-3030352
    Thank you.

    Note : The rows with (*) should be filled in properly