Paket Screening COVID-19 (PCR & Rapid Test) untuk Perusahaan

Registration Form Corporate

Please provide all required details to register with Triasse.
Full Name *

First Name Last Name

Your complete name
Position *
Your position in the company's

Your position in the company's
Mobile Number *
Your WhatsApp number

Your WhatsApp number
E-mail Address *
Your company or personal e-mail address

Your e-mail Address
Company Brand's *
Your company's official brand name

Your company's official brand name
Company Name *
Your company's registered name

Your company's registered name
Employee *
Your company's employee

Your company's employee

Company Address *

Registration Form Corporate