Payment method (2) Pay by credit card by filling the following form and send to Alice Lee through email.

Payment method (2)
Pay by credit card
by filling the following form and
send to Alice Lee through email.



Type of Card

□Visa

□Master Card

□JCB

Credit card number


Last 3 digit on
backside of card


Valid Period

Valid from: □□Month/□□Yr

Valid Thru: □□Mon
th/□□Yr

Authorization Code

Leave blank



Pay to

CMPUGTW
台灣平坦化應用技術協會

Transaction Date



Item

For example:
3 days registration, or single day registration

Amount


Name


Affiliation


TEL


Email

(must be the
same email of
registration)


I her
eby agree

to pay the bill
to CMPUGTW
by
Credit Card
through

issuing this letter of
authorization.

Signature:

Email: To:
alice@mail.ntust.edu.tw

o r F a x: + 8 8 6
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2
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2 7 3 7 6 4 6 0, A t t n t o: Al i c e L e e