VIIDA 短期櫃 會員資料建檔 請依照VIIDA短期櫃位「會員申請表」填寫，感謝！ If you are human, leave this field blank.會員基本資料(*為必填欄位)新/舊會員 *新會員現有會員消費地點 *桃園台茂中和環球台中新光新竹巨城三井誠品會員姓名 *性別男女聯絡電話 *會員生日(YYYY/MM/DD)Email信箱 *地址CountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabwe購買日期(YYYY/MM/DD)本次消費金額 *更多會員資訊如何得知VIIDA品牌網路廣告親友介紹購物時路過得知其他平常會關注的議題 (可複選)美食/餐廳 親子攝影營養保健運動健身環保閱讀音樂電影園藝旅遊美容烹飪此次購買產品 (可複選)Soufflé 抗菌不鏽鋼餐具組Soufflé 抗菌不鏽鋼餐盤Soufflé 抗菌不鏽鋼餐碗Soufflé 抗菌不鏽鋼杯Soufflé 抗菌不鏽鋼叉匙組(S)Soufflé 抗菌不鏽鋼叉匙組(L)Joy 便攜式矽膠圍兜 (動物款)Joy 便攜式矽膠圍兜 (素色款)Joy 防滑矽膠餐墊Joy 多功能分隔盤Joy 環保矽膠吸管Chubby 防水收納袋(S)Chubby 防水收納袋(L)Kitty 用餐套組Kitty 幼兒外出組Kitty 大童外出組CiPU 野餐套組Glow 多功能食物剪Kasten 便當盒Kassie 便當盒Karrie 便當盒Karrie 分隔盒Karrie 分隔盒Kasten 分隔盒Tessa 手袋Sammy 手袋客製化雷雕姓名餐具銷售人員 *送出
