ORDER FORM
Customer Order Number: Date: yyyy mm dd
Name: Signature:

Billing/Invoice Address (Block Capitals):

 Delivery Address if different from opposite:
กด Post Code:

กด County:

กด Post Code: กด County:
กด Tel No: กด Tel No:

กด Fax No:

กด Fax No:
กด E-mail Address: กด E-mail Address:

Qty
Model
Description
Price
(per unit)
Total Cost
US$ US$
US$ US$
US$ US$
US$ US$
US$ US$
US$ US$
US$ US$
US$ US$
US$ US$
     
plus Carriage US$
     
Grand Total US$

I will T/T remit to your bank account

Bank Account :
Hua Nan Commercial Bank Ltd. Tun-Hwa Branch/Taipei
Address: 1F., No. 2, Sec. 2, Tun-Hwa South Road, Taipei, Taiwan, R. O. C.
A/C. No. 130-51-000043-0
Beneficiary: TECPEL CO., LTD. Swift Code: HNBKTWTP
I enclose bank check# to the value of US$
I wish to pay by MASTER CARD VISA *** Payment by Credit Card, please print this page and sign it back to us by fax.

Card Holder Name:
Card Number is - - -
Valid From: Expiry Date: / Security Code
Shipping Address same as on card? YES NO

X______________________________________________ (Signature)

Post to: 4F-1, No. 225, Sec. 3, Heping East Road, Taipei, 11056, Taiwan, R.O.C.
Tel: 886-2-27375866 Fax: 886-2-27373343 E-Mail: sales@tecpel.com URL: http://www.tecpel.com