京點付款回覆
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訂購人姓名 *
訂購人行動電話 *
付款方式 *
帳號末五碼 (是金融卡卡號，非信用卡卡號)：
Captionless Image
填寫當時備註的資料：
付款金額 *
付款日期  (填寫西元年份，例如：202X) *
MM
/
DD
/
YYYY
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