Product Name	Unit Price	Shipping & Handling		Quantity	Sub-Total
		DHL/UPS	EMS Express
Total

Personal Data

Name: ________________________________ Country: _________________________

Shipping Address:________________________________________________________
(Please make sure the shipping address is complete, correct and legible in type writing.)

E-Mail: ______________________________________________ (for Order Confirmation)

Phone No: __________________________ Fax No.: ___________________________

Credit Card

Card Holder: _________________________Card Issued by: _________________________

Please check: VISA MASTER JCB Card No.: __________________________________

Expired Date: _______ / _______ Signature: ____________________________________________

Card Security Code: __________
(It is the last 3 numbers located at "Signature Area" of the Credit Card.)