Application Form of Rename,Alias,Pen-name

My Info

Item:

Original name:

Sex *

Birthday:

*
( If was born abroad, please fill in foreign time )

Birth place:

Remark:

Contact Information

Contact person:

Address:

Tel:

Mobile:

Email:

Remittance:

Bank:

Currency *

Remittance date

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Please carefully check the contents:

Item:
Word:　Original name:　Sex:
Birthday:　
Birth place:

Remark:

Contact person: Address:
Tel: Mobile: Email:
Remittance: Currency: Bank:
Discount amount: RMB

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Password: *

Confirm password: *

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