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: |
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Company Name: |
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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) |
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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)
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*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) |
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DHL | FedEx |
UPS |
U.S. Postal Service |
Instruction / Remarks: |
Comments:
Copyright (C) 1997
- 2018 Amtron
Technology, Inc.