TOYO KEIZAI INC. Marketing Dept.
1-2-1 Nihombashi Hongokucho, Chuo-ku, Tokyo 103-8345 / Fax: +81-3-3270-4127
E-mail: sales@toyokeizai.co.jp

JCH ORDER FORM
Please fill out and print this form, and fax it to +81-3-3270-4127.

Latest edition Only
Area price q'ty total amount
Asia JPY 11,900 sets JPY
Europe, North America JPY 13,300 sets JPY
Africa, South America JPY 14,900 sets JPY
Price include postage by EMS.

Name:
Company:
Zip Code:
Mailing Address:
Country:
Tel:
Fax:
E-mail

Credit Card
PAYMENT (We accept credit card payment only.)
Charge my: VISA / MasterCard / UC / JCB /
American Express / DC/UFJ
Card Number:
Holder's Name:
Expiration: month / year
Signature: