<b>Info Harga Payout Pulsa:</b><br /> <font color="black">1. Pulsa 5 Ribu = <b>Rp 6.500,-</b><br/> 2. Pulsa 10 Ribu = <b>Rp 12.000,-</b><br/> 3. Pulsa 25 Ribu = <b>Rp 26.000,-</b><br/> 4. Pulsa 50 Ribu = <b>Rp 53.000,-</b><br/> 5. Pulsa 100 Ribu = <b>Rp 102.000,-</b></font><br/> <div class="alinea"></div> <div class="registration-login"> <form method="post"> <p>Pilih Operator:<br/><select name="method"> <option value="Telkomsel">Telkomsel</option> <option value="Indosat">Indosat</option> <option value="XL Axiata">XL Axiata</option> <option value="Axis">Axis</option> <option value="Three">Three</option> <option value="Smartfren">Smartfren</option> <option value="Esia">Esia</option> </select></p> <p>Nominal Pulsa:<br/><select name="amount"> <option value="6500">5 Ribu</option> <option value="12000">10 Ribu</option> <option value="26000">25 Ribu</option> <option value="53000">50 Ribu</option> <option value="102000">100 Ribu</option> </select></p> <p>NO HP: (Contoh: 08123456789)<br/><input type="text" name="via"/></p> <p>Nama Anda:<br/><input type="text" name="name"/></p> <p><input class="button" type="submit" value="Submit"/></p> </form> </div>';