Payment Confirmation

Propcon Payment Confirmation

Personal Data.
First Name(*)

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Last Name

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Telephone(*)

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Mobile Phone(*)

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E-mail(*)

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Address(*)

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PAYMENT INFO
For Payment(*)

Annual Membership
Sponsorship
OthersPlease specify your purpose of payment
Your Account Name(*)

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Your Account Number(*)

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Your Bank Name(*)

Please type your Bank Name
Date of Payment(*)

Please type your Date of Payment

Please click the pop up calendar
Date of Submission(*)

Please type your date of submission

Please click the pop up calendar
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
Upload your scan of transfer payment

Invalid Input
Or fill in your Transfer Note

Please type your address
PROPCON GOLF CLUB,
Bank BCA, KCP Suryopranoto, Jakarta,
Acc # 261-3030352
Thank you.

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