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$
     
plus Carriage US$
     
Grand Total US$
  Verification Code:    

I will T/T remit to your bank account

Bank Account :
Hua Nan Commercial Bank Ltd. Tun-Hwa Branch/Taipei
Address: 11F, NO. 182, DUNHUA SOUTH ROAD, SEC. 2, DA'AN DISTRICT 10669 TAIPEI, TAIWAN
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 PayPal *** 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: 11F, NO. 182, DUNHUA SOUTH ROAD, SEC. 2, DA'AN DISTRICT 10669 TAIPEI, Taiwan
Tel: 886-2-27375866 Fax: 886-2-27373343 E-Mail: sales@tecpel.com URL: http://www.tecpel.com