CREATE ACCOUNT

Member Information

Member Type

Full Name / Company Name

Username

Email Address

Member Details

Home Address as Stated in ID / Company Address

Province

Region

Postal Code

ID No

No. Telp/HP*

NPWP No

SPPKP No (Surat Pengukuhan Pengusaha Kena Pajak)

Authorized Person to Sign Agreement Letter

Other Seed Source Beside Dami Mas

PIC

PIC HP No

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Estate Location

Estate Area (Hectare)

Group Company Name

Group Address

Group NPWP No

Group SPPKP (Surat Pengukuhan Pengusaha Kena Pajak)

*) required fields