Register AIYARA

Register

Language
Thai US Cambodia

Under A12779

Line type B

Referral UserName ธีระพงษ์ เสพสุข ( A12779 )

Business Location

Name Prefix

First Name *

Last Name *

Business Name * If there is no business name, enter (-)

Marital status

Aay/Month/Year of birth

Country *

Nationality *

ID card number *

Mobile Phone *

Home Phone

Address on ID card

No. *

Name village/building *

Village No.*

Lane *

Road*

Province *

District/Area *

Sub-district/Sub-area *

Zip Code

Convenient address for contact and home delivery of products.

Use address on ID card

No. *

Name village/building *

Village No. *

Lane *

Road *

Province *

District/Area *

Sub-district/Sub-area *

Zip Code

Banking Account

Account Name

Account No.

Bank

Branch

Account Type

Savings

Current account

Successor

Beneficiaries (Name Surname)

Relationship

ID card number

Documents for applying

ID card photo *

Straight face photo *

Photo of a straight face holding an ID card *

Bank account photo *