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Times Privilege Card (TPC)

 


  Please Tick One
NEW: 1year 2 year Renewal 1 year 2 year 3 year     

Personal Particulars IN BLOCK LETTERS
Full name as in KTP/SIM (please underline surname) :  
Name to appear on card (22 characters) : KTP / SIM No.:
Date of Birth : Gender : Male Female Martial Status : Single Married Other
Monthly Income : Below 2.000.000 IDR Below 2.000.000 - 5.000.000 IDR Below 5.000.000 - 10.000.000 IDR 10.000.000 IDR and Above

Occupations Profesional Secretarical & Clerical Teacher/Academic/Lecture
  Bussinessman Student Homemaker
  Executive Managerial Others
       
Education High School University
  Academic Other  
Mailing Address
Postal Code    
Home Tel1: Home Tel2: Office Tel3:
Mobile1:
Mobile2:      
Email    

Your Interest(s)

FICTION NON FICTION GENERAL
Profesional Asian Interest Art
Crime Biography Architecture & Design
Horror New Age Beauty & Fashion
Humour Politics & Current Affairs Coolinery
Literature Religion Games / Sports
Romance Science Geography
Sciences Ficiton / Fantasy Self - Improvement Health
Thriller Technology History
    Hobbies & Crafts
    Home & Garden
    Humanities & Social Sciences
    Military & War
    Travel
     
BUSSINES CHILDREN MULTIMEDIA
Bussiness & Management Preschool & Toodler Educational Software
Computers Primary VCD/DVD
E-Commerce Teens
Finance & Investing  
Human Resource Management    
Marketing / Branding    
Public Relations    
Sales    
Small Bussiness & Enterpreneurship

I agree to abide by the terms & conditions stated in the application form
 

Please PRINT and bring your printed copy to our store. The printed copy of the TPC Application Form is REQUIRED for making payment to receive your temporary card