Fax Order Form
Please Fax to: +81-42-848-5148
Please print out this form, fill it in completely and fax us at: +81-42-848-5148
We will contact you shortly to confirm your order.
PRODUCT(S)
Product Number Product Name Qty Amount
_______________ ___________________________________________ ______ US$___________
_______________ ___________________________________________ ______ US$___________
_______________ ___________________________________________ ______ US$___________
Shipment: FREE Shipping
PAYMENT METHOD
VISA___ MASTER___ AMEX___ PayPal___
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: MUFG Bank, 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
Ion Trading by Universal Plan Co., Ltd.