Fax Order Form
Please Fax to: +81-42-571-4487
Please print out this form, fill it in completely and fax us at: +81-42-571-4487
We will contact you shortly to confirm your order.
PRODUCT(S)
Product Number Product Name Qty Amount
_______________ ___________________________________________ ______ JPY___________
_______________ ___________________________________________ ______ JPY___________
_______________ ___________________________________________ ______ JPY___________
Note: The shipping charge is added to all orders. (2,000JPY(approx. US$20) per shipment)
PAYMENT METHOD
VISA___ MASTER___ AMEX___ PayPal___ Money Order___ Bank Check___ Bank Transfer___
CREDIT CARD INFORMATION (when pay by Credit Card)
Name as it appears on credit card: _______________________________________________________
Card Number:
Expiration Date: ____________________________________________________________ (mmyy)
3/4 digit security code: ____________________________________________________________
Signature: ____________________________________________________________
PAYPAL ACCOUNT (E-mail address) (when pay by PayPal)   __________________________________
BILLING ADDRESS (address to which your credit card bill is sent)
Name:  Mr. / Ms. ____________________________________________________________
Company: _________________________________________________________________
Address: _________________________________________________________________
Phone: ___________________________   FAX: ___________________________
DELIVERY ADDRESS (if different)
Name:  Mr. / Ms. ____________________________________________________________
Company: _________________________________________________________________
Address: _________________________________________________________________
Phone: ___________________________   FAX: ___________________________
BANK ACCOUNT INFORMATION
Bank: The Bank of Tokyo-Mitsubishi UFJ, Ltd.
Branch: Kunitachi Ekimae (No.512)
Account No: 3594703
Account Name: Universal Plan Co., Ltd.
Address: 1-4-12, Higashi, Kunitachi-city, Tokyo 186-0002 Japan
Swift Code: BOTKJPJT
MONEY ORDER OR CHECK SHOULD BE SENT TO:
Company Name: Universal Plan Co., Ltd.
Address: 1-16-41, Nishi, Kunitachi-city, Tokyo, 186-0005 Japan
Ion Trading by Universal Plan Co., Ltd.