DIEKSPOR - Form Pemesanan

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d i e k s p o r

SHIPPER

Name

Email Name

Phone Number

Address

RECEIVER

Name

Email Name

Phone Number

Address

Destination

Service

Unit Length

Length (Only input number)

Width (Only input number)

Height (Only input number)

Actual Weight (Only input number)

Box Content Information

Approx Value for each item

Agent’s name (if applicable)

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