Fax Order Form of Amtron Technology Inc

PO Box 884
Monterey Park, CA 91754 USA
Tel: (323) 265-8076 Fax: (323) 488-9747
http://www.amtron.com

Fax Inquiry or Order Form

[If the space provided below is not enough for you to fill in all input, please use the "comments" section at the end of this form to complete your input.]

Your Name:
Company Name:
Mailing Address	Number / Street:
	City:	State / Province:
	Country:	Zip / Postal Code:
Contact Information	Telephone:	Fax:
	E-Mail:	Other:

Product You Want to Order	Unit Price (US$)	Quantity
(1)
(2)
(3)
(4)
(5)

Payment (Please select one by a circle or a check mark)
Credit Card	PayPal	Bank Wire Transfer (T/T)	Purchase Order	COD

If you choose credit card as payment method, please provide the following information

Credit Card (Please select one by a circle or a check mark)	American Express	MasterCard	VISA	Discover
Number:		Expiration Date:
Card Holder Name:		*CVV Number :**
Billing Address: (If different from the shipping address)
CARD VERIFICATION VALUE CODE (CVV*): (a) This number is printed on the back of your MasterCard & Visa cards. (it is the last 3 digits AFTER the credit card number in the signature area of the card). (b) You can find your four-digit card verification number on the front of your American Express credit card above the credit card number on either the right or the left side of your credit card.

Method of Shipment (Please select the one you prefer; read our shipping policy for the details)
DHL	FedEx	UPS	U.S. Postal Service
Instruction / Remarks:

Comments:

Please fax the above information to Amtron Technology at (323) 488-9747 or e-mail to sales@amtron.com .

International Customers: We will inform you of the shipping method and cost via e-mail or fax. We will not process your order until we receive your confirmation about the shipping method and charge.