FORM PEMBELIAN KACAMATA

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Nama Lengkap

Alamat Tujuan

isi data lokasi pengirim lengkap

Alamat Nama Tujuan

Nomor HP

nomor aktif

JENIS LENSA

• Single Vision
• Kryptok
• Progresif
• Transisi

BAHAN LENSA

• Supersin / crmc
• Photocromic
• Blurcromic Onedrive

FITUR LENSA

• First Choice
• Second Choice
• Third Choice

JENIS FRAME

• Standar
• Premium

MODEL FRAME

• Tipe 8010
• Tipe 80001

Total

Order Summary

Item	Quantity	Total
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Total		$0.00

$0.00

Catatan

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