Fax Payment Form

Order Information ()

Gift Certificate #MSSGC1066511331
- Amount:US$ 20
Sub-Total: US$ 20
 Shipping:US$ 0
Micro-shipment surcharge: US$ 10
Total: US$ 30

Credit Card Information

Amount to payment US$
Visa Card
Master Card
AMEX
JCB Cards
Cardholder's Name
Credit Card Number*
CVV/CVC*   What is CVV/CVC?
Expiration Date    
Issuer Bank Country*
Issuer Bank Name*
Cardholder's Signature

 


Billing Information

Name:
Email Address:
Billing Address:
City:
State/Province:
Country:
Zip Code:


To fax this form:

  1. Fill in all the necessary information
  2. Print
  3. Fax the form to Mysuitshop at (66)-(02) 650-0956
    ( Note: 66 is the country code for Thailand and 02 is the area code for Bangkok . )

Or
If faxing from the USA , you can fax to ( +1 ) 703 997 5593
If faxing from the UK , you can fax to ( +44 ) 2079 003 541