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

Billing/Invoice Address (Block Capitals):

Delivery Address if different from opposite:
Post Code:

County:

Post Code: County:
Tel No: Tel No:

Fax No:

Fax No:
E-mail Address: 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
Bank Address: NO. 2, SEC. 2. DUNHUA SOUTH ROAD, 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: 3F., No.12, Lane. 130, MinQuan Road., XinDian Dist., New Taipei City 23141, TAIWAN
Tel: 886-2-2218-3111 Fax: 886-2-2218-3222 E-Mail: sales@tecpel.com.tw URL: http://www.tecpel.com