| ORDER SPECIFICATION |
YOUR INVOICE NUMBER(你的發票號碼) | |
PART NUMBER(Part編號) | |
TOTAL AMOUNT(JPY)(總共多少日幣) | |
| SHIPPING INSTRUCTION |
COMPANY NAME(公司名稱) | |
CUSTOMER NAME(你的姓名) | |
PHONE(電話) | |
FAX(傳真) | |
E-mail(電子郵件) | |
SHIPPING ADDRESS(郵寄地址) | |
COUNTRY NAME(國家名稱) | |
POSTAL CODE(郵遞區號) | |
| PAYMENT INFORMATION |
Please choose a method of payment(請選擇付款方式) | WIRE TRANSFER(電匯)
CREDIT CARD(信用卡)
|
| PAYMENT BY WIRE TRANSFER |
BILLING NAME | |
|
BANK NAME : | The Bank of Tokyo-Mitsubishi UFJ,Ltd. | BRANCH : | EKODA | PHONE : | +81-3-3953-4116 | ADDRESS : | 1-74-7 ASAHIGAOKA NERIMA-KU TOKYO 176-0005 JAPAN | FOR CREDIT TO : | GRUPPEM INC. | ACCOUNT NO : | 0910539 |
|
|
| PAYMENT BY CREDIT CARD |
CARD TYPE (卡別) | |
BILLING NAME (卡片登記姓名) | |
CARD NUMBER (卡號) | |
| EXPIRY DATE |
MONTH (有效月) | |
YEAR (有效年) | |
SECURITY CARD NUMBER (卡片背面檢查碼) | (last 3 Digit at the back of the card) |
