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千隊之王匯款確認單
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* Indicates required question
學校
*
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系所
*
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組別
*
男子/女子
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匯款人姓名
*
請填寫真實/正確性名
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匯款時間
*
例：3/25 14:30
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匯款方式
*
轉帳
無摺
ATM轉帳
其他
匯款金額
*
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匯款後五碼(請填寫匯款帳號的最後五位數字並於數字前加「+」)
轉帳須填寫此欄
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匯款局號（請於數字前加「+」）
無摺需填寫此資訊
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