112年玄武堂-東寒單祈福招財 (發心認捐寒單炮一封捌佰元)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

112年玄武堂-東寒單祈福招財 (發心認捐寒單炮一封捌佰元)

請先匯款後再填寫此表單
匯款戶名:台東玄武堂
匯款銀行:004 臺灣銀行臺東分行
匯款帳號:023001-104206

Sign in to Google to save your progress. Learn more

* Indicates required question

姓名或公司行號名稱 *

Your answer

地址 *

Your answer

手機 *

請留連絡電話,有需要時方便連繫

Your answer

匯款日期 *

MM

/

DD

/

YYYY

匯款帳號(最少要留後五碼) *

最少要留後五碼以利核對

Your answer

認捐封數 *

1封$800

Choose

1封($800)

2封($1600)

3封($2400)

4封($3200)

5封($4000)

6封($4800)

7封($5600)

8封($6400)

9封($7200)

10封($8000)

其他金額

Next

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy