Ndiroleni ndidziwe zambiri zanu zotumizira monga zili pansipa, kuti tikutumizireni ulalo woti mulipire:
(1) Dzina la Kampani/Dzina_______________
(2) Nambala ya foni ________________
(3) Adilesi________________
(4) Mzinda ____________
(5) Dziko____________
(6) Dziko ________________
(7) Zip kodi
(8) Email________________