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Form Pemesanan

Data Pemesan (Wajib Diisi)
Nama*
Alamat*
Telp/HP*
Email*
 
Data Cake
Tanggal Pengiriman*
Nama Cake*
Ukuran*
Jenis Cake*
Nama di Cake*
Usia / Lilin*
 
Data Penerima (Jika dikirim ke alamat lain)
Nama Penerima
Alamat
Telepon
Keterangan
 
Kode Verifikasi
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