Doctor Jel sign up
ទាក់ទង Doctor Jel Line: dr.jel ( Office hour )
Step 1 Registration
Please fill in all required field (* Required)
Email (អ៊ីមែល)*
eg contact.drjel@gmail.com
Password (លេខកូដ)*
Password can be a-z or A-Z or 0-9
Repeat Password (លេខកូដម្ដងទៀត)*
Password can be a-z or A-Z or 0-9
Nick name (ឈ្មោះលេង)*
Title (ខ្ញ្ញុំបាទ/នាងខ្ញុំ)*
Mr
Mrs
Miss
First name (ឈ្មោះពិត)*
Last name (នាមត្រកូល)*
Passport (លេខអត្តសញ្ញាណប័ណ្ណ)
Sponsor (លេខidនាក់នែនាំ)*
Telephone (លេខទូរសព្ទ)*
At least 1 Number
LINE ID (idឡាយ)
Facebook (ឈ្មោះfb)
Instagram (អ៊ីនត្រាក្រាម)
Step 2 Choose Doctor Jel product 1 set រើសផលិតផលមួយសេត (Set price 100$)
Deposit to ផ្ញើលុយចូលទៅ
Account number លេខកុងធនាគា001454321 ABA Bank
Account name ឈ្មោះលេខកុងធនាគា Ung Chansora
Recipient (ឈ្មោះនាក់ទទូល)
Telephone (លេខទូរសព្ទ)
Recipient address (កន្លែងនាក់ទទូល)
Transfer slip (ក្រដាសផ្ញើលុយ)
*** The uploaded image file is large (more than 1.5 mb). It takes longer and may not upload successfully while uploading. If upload failed Please contact It Service (010614566), Send the slip you want to upload to Line ID: dr.jel .