ASM Overseas Corporation Credit Card Charge Authorization Form
Jian Wai SOHO, Building 11# 2805,ChaoYangDistrict, Beijing, China. 100022
Beijing office Tel: 86 10 5166 1575, Fax: 86- 10- 5900 2947
E-Mail: firstname.lastname@example.org , Internet: http://www.cbw.com
Please fill out the form, have it signed by the CARD HOLDER and fax it back to us. Please note ASM
Overseas Corporation will appear as the company charging you on your credit card statement.
“ASM Overseas Corporation”以信用卡支付我们将加收 4%的银行服务费。
Date: Invoice/File Number:
Charge Amount: +4%(Bank charge)
Card Holder's Name (First Name, Middle Initial, Last Name):
Credit Card Type: Visa Master Card American Express (no other cards accepted at present)
Credit Card Number:
Expiration Date (MM/YY):
State: Zip Code: Country:
I thereby authorized ASM Overseas Corporation to deduct the stated amount from my credit card.
FOR REFUND: A Cancellation Charge $15 USD plus 4% of Banking Service (by banks involved in
processing) will be calculated and deduct from refund amount.