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- <form method="post" action="https://docs.google.com/forms/d/e/1FAIpQLSf2L4TM8S8bsvvko29L31EiT2uMhmM-ysTL9f_n2FW6V0UGjQ/formResponse?" method="post">
- <input type="hidden" name="_token" value="F0UHlq6l4qsi1OywfYqC7KEJ4BC1OL5uvcM9s3kg">
- <div class="form-group">
- <input type="text" placeholder="Nama Lengkap" name="entry.1331368535" id="nameField"class="form-control" required>
- </div>
- <div class="form-group">
- <input type="number" placeholder="Telepon" name="entry.871150175" id="mobField" class="form-control" required>
- </div>
- <div class="form-group">
- <input type="number" placeholder="Telepon Tambahan" name="entry.128696371" id="mobField2" class="form-control">
- </div>
- <label class="lb-check">
- <input type="checkbox" id="dropship"> Saya ingin menjadi reseller
- </label>
- <div class="form-group" id="isDropship">
- <input type="email" placeholder="Email" name="entry.1103129650" id="mobField3" class="form-control">
- </div>
- <div class="form-group">
- <input type="submit" value="Pesan Sekarang" class="btn btn-block">
- </div>
- </form>
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