Wanda Technology Inc.

* Required information

Wanda Technology Inc.
Tel. (714)549-4448 | Fax: (714)549-4458 | Email: Sales@wandatech.com

Please read carefully and complete the following information. Please return the forms to Wanda Technology by fax or e-mail. Failure to complete all the information accurately may result in delay or cancellation. Any additional cost accrued due to inaccurate or incomplete information will be the responsibility of the buyer.

* I agree to perform the obligations set forth in the Card member's agreement with the issuer and to pay applicable shipping and insurance (misc.) charge to Wanda Technology Inc.

Purchasse Order Number	(If applicable)
Telephone Number *
Sales Order Number	(If applicable)
Total Amount (Check Freight) *	USD $ (Excluding Freight)

Credit Card Information:

Card Holder's Name *
Card Number *
Card *
Expiration Date *	mm yyyy
Signature Panel Code (Verification code) *	( is the last 3 digit on the BACK of the credit card)

Card Holder Information

First Name *
Last Name *
Company
Email *
Telephone *
Fax
Address *

City *		Zip Code *
Country *		State*

ShipTo: (If Different from Card Holder name & address) *