Mr./Mrs./Ms./Dr./Other
First name
Last name
Job title
Organization / Company
Nature of business
Address
Country Tel. No.
Fax No. E-mail
Method of payment
Please note : Payments must be received with booking .
Payment will be acknowledged with an invoice.
Cheque / bankers draft enclosed for $ 250.00
payable to DELTA TRADING CO.
Please charge credit card for US $ 250.00
[ ] Master Card [ ] Visa [ ]
AMEX
Others …………
Card Number
Expiry date …………. Issue No.
Signature:
Card holder name:
For extra application for your colleagues , please make copy of this or immediately fax +9626-5699104 to get copy