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

stingymilitaryElectronics - Devices

Nov 27, 2013 (3 years and 8 months ago)

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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