Customer Registration
Customer Registration
Applicant Information
*
Full Name
** Required Field
*
Username
** Required Field
*
Country
Select a Country
Thailand
** Required Field
*
State / City
Select a State / City
** Required Field
*
Handphone No
(eg.:
xxxxxxxx)
** Required Field
*
Email
** Invalid Email
** Required Field
Introducer Information
*
Username
Introducer ID
** Required Field
Item
Package Code
Description
Unit PV
Selling Price
Quantity
Total PV
:
0
Total Amount
:
0
Grand Total
:
0
Collection Mode
:
Self Collect
Mail Delivery
Payment Information
Others
Bank Transfer
*
Transaction ID
*
Amount
:
*
Upload Slip
:
Choose File
Delete All
Choose File
File Type : .jpg, .jpeg, .png, .pdf
** Maximum file size is 5MB
Account Login Information
Password (6-10 alpha numeric)
** Required Field
Re-enter Password
** Password and Re-enter Password Must be Same
I declare that all the information is accurate and true to the best of my knowledge and I agree to abide and be bound by the terms and conditions set forth in the application.