Mitra PaxelCo Form

To work as a Paxelco, you must at least have a legitimate company (PT/CV)

E-mail Address *

E-mail Address should not empty

Proposed Area/City/District *

Proposed Area/City/District should not empty

Owner of the company *

Owner of the company should not empty

Owner’s phone number *

Phone number should not empty

Company name (PT/CV) *

Company name should not empty

Company address (PT/CV) *

Company address should not empty

Business field (PT/CV) *

Business field should not empty