Credit Card Form

Credit Card Secure Order Form

Please complete and print out this form. After putting signature of the credit card holder, fax it to Talitor(Far East) Company Limited at Fax no.: +886-2-8511-0028

Authorization of Credit Card Holder

The undersigned credit card holder is purchasing the following listed items form Talitor (Far East) Co. Ltd. ,and agree to make payment through credit card due to not being able to personally present at the spot of this transaction made. The credit card holder shall bear NO responsibility other than this order form.


Date of order	Month Day Year
Type of credit card	VISA Master JCB
Credit card number
Last 3 digitals on the reverse side of Credit Card
Credit card valid through
Bank of issue
Name of card holder
Total amount of purchase

Signature of card holder

Purchasing Items

Model number	Products description	Unit price	Quantity	Total








Sub Total
Credit card payment handling charge 3%
Total amount of purchase

For Seller's use only :

Authorized number :

Company Code :

Please insert rows of this form if these are insufficient for listing purchasing items, otherwise delete those without being used.

This electronic transmittal is intended exclusively for Talitor(Far East) Co.Ltd., and may contain confidential and/or privileged material. Any disclosure, copying, distribution or other action based upon the information by persons or entities other than the intended recipient is prohibited and illegal. If anyone receives this message in error, please disregard and destroy this material immediately. The sender of this transmittal knows that the recipient, Talitor(Far East) Co., Ltd., is not warranted to receive this transmittal unless the recipient returns an acknowledgement.