FORMULIR PESERTA GEA BERKURBAN 1436 H

QURBAN ATAS NAMA

1. ........................................... bin .........................

2. ........................................... bin .........................

3. ........................................... bin .........................

4. ........................................... bin .........................

5. ........................................... bin .........................

6. ........................................... bin .........................

7. ........................................... bin .........................

NO. HP/TELP

EMAIL

TIPE HEWAN QURBAN (KAMBING)

Type A (21-23 kg) Rp 1.750.000 □ ........ ekor

Type B (24-25 kg) Rp 1.900.000 □ ........ ekor

Type C (26-28 kg) Rp 2.100.000 □ ........ ekor

Type D (29-31 kg) Rp 2.300.000 □ ........ ekor

Super (33-37 kg) Rp 2.500.000 - Rp 2.850.000 □ ........ ekor

Istimewa (38-43 kg) Rp 3.000.000 - Rp 3.500.000 □ ........ ekor

Spesial (45-70 kg) Rp 3.600.000 - Rp 4.500.000 □ ........ ekor

PEMBAYARAN

□ Cash

□ Transfer (Bank..............................................)

TANGGAL ............................................... 2015

TANDA TANGAN

NAMA JELAS

FORMULIR PESERTA GEA BERKURBAN 1436 H

QURBAN ATAS NAMA

1. ........................................... bin .........................

2. ........................................... bin .........................

3. ........................................... bin .........................

4. ........................................... bin .........................

5. ........................................... bin .........................

6. ........................................... bin .........................

7. ........................................... bin .........................

NO. HP/TELP

EMAIL

TIPE HEWAN QURBAN (SAPI)

Type A (200-230 kg) Rp 14.000.000 □ ........ ekor

Type B (240-260 kg) Rp 15.500.000 □ ........ ekor

Type C (270-290 kg) Rp 16.750.000 □ ........ ekor

Type D (300-330 kg) Rp 18.000.000 □ ........ ekor

Super (350-409 kg) Rp 19.000.000 - Rp 24.000.000

□ ........ ekor

PEMBAYARAN□ Cash

□ Transfer (Bank..............................................)

TANGGAL ............................................... 2015

TANDA TANGAN

NAMA JELAS