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YOUR INVOICE NUMBER
PART NUMBER
TOTAL AMOUNT(JPY)
COMPANY NAME
CUSTOMER NAME
PHONE
FAX
E-mail
SHIPPING ADDRESS
COUNTRY NAME
POSTAL CODE
Please choose a method of payment
WIRE TRANSFER CREDIT CARD
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
CARD TYPE
CARD NUMBER
MONTH
YEAR
SECURITY CARD NUMBER
(last 3 Digit at the back of the card)
發票號碼
料號
總金額日幣
公司名稱
CUSTOMER NAME客戶名稱
PHONE電話
FAX傳真
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POSTAL CODE郵遞區號
付款方式
WIRE TRANSFER匯款 CREDIT CARD信用卡
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CARD TYPE信用卡種類
BILLING NAME信用卡持有人姓名
CARD NUMBER卡號
MONTH到期月
YEAR到期年
SECURITY CARD NUMBER卡後末三碼
