邵长文改命堂

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: *
Mobile: *
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: Mobile:
Address:
Remittance: Currency: Bank:
Discount amount:  RMB 
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