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APPLICATION FORM PLEASE PRINT CLEARLY
1. (street address Japan) ____________________________
2. Name to accept mail in: _____________________
3. Code word or Number for future instructions ______________________________________
4. Name to forward mail to you: (Please note. One personal name & one Company name is acceptable in most cases. See each country as we may be able to arrange mail in unlimited names). _________________________________________________________________
Use "Asia Street Address" as your ordering code.
To pay by Bank wire, Liberty Reserve, Pecunix, PayPal, MoneyGram or Western Union please proceed to and order at our secure web site order form at https://www.ptshamrock.com/order_bwe.html Your order code is "Asia Street Address."
To order and pay by CREDIT or DEBIT CARD:
Credit cards accepted:
° Visa
° Visa Purchasing
° MasterCard
Debit Cards accepted
° Visa Debit (Delta)
° Visa Electron
° International Maestro (via 3D secure processing only)
For GBP processing we also accept the following debit cards:
° UK Domestic Maestro (Switch)
° Solo
Aa 5% surcharge has been added for all credit/debit card orders. Please click on the SUBMIT button below. You will be taken to our secure credit card payment centre. Please type in your email address, then click CONTINUE and fill in the requested credit/debit card information.
Thank you for your business.
PT Shamrock |