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.