Date:
To: Marketing & Sales Dept.
Mitsubishi Chemical Techno-Research Corporation
Fax: +81-3-5226-0741
4F Kojimachi-Tokyu Bldg., 6-6 Kojimachi,
Chiyoda-ku, Tokyo 102-0083, Japan
ORDER FORM for FAX
Send me the report entitled "Petrochemical Industry in Southeast Asia 2007 " according to the following instructions (please type or print):
Name: .................................................................................................................................................................................................
Title and department: ..............................................................................................................................................................
Company/organization: ..........................................................................................................................................................
Address:
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Telephone: ..................................................................................
Facsimile: ...................................................................................
E-mail: ...........................................................................................
Number of copies: ................................................................
Amount in US dollars: $.........................................
(@$4,000.- X ..................copy(ies))
(including overseas air delivery charges for orders from overseas):
Payment term: Advanced payment by a bank remittance.
Signature:........................................................................................................................................