Membership application
http://www.chinesesuppliers.org
Please complete this form and fax it to 1-866-838-2619
| Your Name: |
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Job Title: |
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| Company: |
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| Telephone: |
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Fax number: |
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| Post address: |
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| City: |
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State: |
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| Country: |
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Zip code: |
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| Email address: |
(will be your user id) |
| Major products or services: |
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Payment
[ ] Credit card [ ] T/T [ ] Check/Money Order [ ]Paypal [ ] Western Union
[ ] Moneygram
Credit card information
Card Number: ______________________________ Expire Date (month/year)
__________
Card Holder Name: _________________________ Verify Code (CVV):
_________________
Billing address:
______________________________________________________________
City: ___________ State: _________ Country: __________
Zip code: ___________
Your Signature and date:
___________________________________ Date: ___________
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| Membership fee |
145.00USD |
Total amount: |
________USD |
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You can also mail this form as well as your payment to:
INTBIT INC, PO BOX 2502 ROCKVILLE MD 20847 USA.
Check/money Order must be payable to INTBIT INC
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