Payment Form – Gitai Ambassadors

First Name *

Last Name

Email Address *

Phone *

Who Invited You *

Signup Fee *Promo Amount N 35,000Official Amount N 70,000

Upload Clear Proof Of Payment *

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Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code

Country *

Upload A Clear Government Valid ID Card * *

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Upload A Clear Selfy Of You Holding Your Government Valid ID Card *

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