Customer Information

Customer Information Form

Company Information

Company Name

Company Address

Tax ID

City

Country

Main Contact

Main Contact Title

Mr.

Mrs.

Main Contact Name

Main Contact Nickname

Main Contact Mail

Main Contact Phone

Main Contact Fax

Purchasing Department

Purchasing Contact Tiltle

Mrs.

Purchasing Contact Name

Purchasing Contact Nickname

Purchasing Contact Mail *

Purchasing Contact Phone

Purchasing Contact Fax

Accounting Contact

Accounting Contact Title

Mrs.

Accounting Contact Name

Accounting Contact Nickname

Accounting Contact Mail

Accounting Contact Phone

Accounting Contact Fax

Payable Accountant

Payable Accountant Contact Title

Mrs.

Payable Accountant Contact Name

Payable Accountant Contact Nickname

Payable Accountant Contact Mail

Payable Accountant Contact Phone

Payable Accountant Contact Fax

Payable Accountant Contact Payment Method

Shipping Details:

Shipping Address

Shipping City

Shipping Postal Code

Shipping Country

Send

Remarks:

Requirements:
* Hardware and Software have to be paid on the delivery date
* Some service or item require a deposit
* Late payment fee must be the charged 1.5% from the due date

Please make your check payable and crossed to:
Safecoms Network Security Consulting Co., Ltd. Or Bank transfer to
Kasikorn Bank, Sukhumvit 33 Branch

Saving A/C 003-2-19556-5 Swift Code Kasithbk