| Name： |
|
| Mail Address： |
|
| Paymennt： |
Telegraphic Trasfer (You should also pay the Bank charge) |
|
Postal Money Order |
|
Bank Draft |
|
Credit card settlement（Please fill out ＊mark column
of the lower berth.) |
Postal Code：
Address：
City：& State |
(Digicode ： in France)
Country ： |
Telephone No.：
Fax No.： |
|
＊Credit company
& A menber of card number |
like VISA 1234 2345 -- |
| ＊Name & Expiration date |
like TAKESHI NISHI-- /05-08 |