Credit Card Order Form

To: We World Chinese Culture Digital Publishing., Inc.

Fax: 886-2-2367-3200 // Tel: 886-2-2367-2900

(Attn: Miss. Chou -- Marketing Department)

　

    ___  Group Member – ( Application for Group annual membership )

    ___  Single Member  – ( Application for Single annual membership )

    ___  Personal Short Term Member – ( Application for Personal  short  

                 term membership )

• Price：_____________                               

                                       ___ VISA    ___  Master Card   ___  JCB

• Authorization bank：_____________________________

• Credit Card Number : _____________________________ 

•  Expiration Date ：______ Year  _____ Month

• Signature ：_____________________ 

          (The signature should the same as your signature on the credit card)

• Authorization NO. ：__________________  (Please leave blank) 

• Name：_________________ E-mail：_________________________

• Phone number：(O) _________________  (H) __________________

• Contact address：_______________________________________________

• Consigner：________________________

• Consigner address：______________________________________

Please fax back this order form to our marketing department, thank you !