Reseller :
. (Kosongkan
bila end-user)
Reseller
Leave
blank for end-user
No. Pelanggan :
.
Customer No.
Nama :
.
...
Name
Perusahaan :
:
...
.
Company
No. Telepon :
.......
Telephone
Mohon kuota ditingkatkan menjadi: Rp
.... (Terbilang:
Please upgrade our quota to
Amounting:
.... .)
Jakarta, 2003
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