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To order, please reprint the following and fax to +607-4321221:

Name:  
Title:  
Company Name:  
Shipping Address:

 

 

  
Telephone:  
Fax:  
Email:  
Product Code

Qty Ordered

 U.O.M. Unit Price Amount
      US$ US$
      US$ US$
      US$ US$
      US$ US$
Total: US$

mc.gif (1308 bytes)    or   L.C. for quantity order.

MASTER Credit Card Information: 

MASTER Card holder's name:  
MASTER Card Number:  
Expiry Date:  
Credit Card Billing Address:

 

 

  
Total amount to credit:

 

  

 
Credit Card holder's signature:

 

 

  

 

 

 

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Last modified: 14/10/1998.

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