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China SIM Card Rental
China SIM Card Rental DETAIL
Coupon:
Equipment Requested:
*
China Sim Card
CUSTOMER INFORMATION
Full Name:
*
Home/Office Phone Number:
*
E-Mail Address:
*
( Your must enter an correct email address for notification/communication )
DELIVERY INFORMATION
Home Receiver/Hotel/Company Name:
*
Phone # (of hotel or contact person):
*
Street Address:
*
City:
*
State:
*
Country :
*
ZIP Code:
(If deliver to China, no State and Zip code needed)
Arrival Date:
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
-
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-
2007
2008
Time:
0:00 ~ 2:00
2:00 ~ 4:00
4:00 ~ 6:00
6:00 ~ 8:00
8:00 ~ 10:00
10:00 ~ 12:00
12:00 ~ 14:00
14:00 ~ 16:00
16:00 ~ 18:00
18:00 ~ 20:00
20:00 ~ 22:00
22:00 ~ 24:00
End date of service
Date:
*
(mm/dd/yyyy)
Month
January
February
March
April
May
June
July
August
September
October
November
December
-
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
-
2007
2008
PAYMENT METHOD
Credit Card We Accept:
Visa
Mastercard
American Express
Discover
JCB
diners
Name as it appears on credit card:
*
(We only take credit card)
Credit Card Number:
*
(Please confirm it)
Exp. Date:
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Year
2007
2008
2009
2010
2011
Security Code:
*
Special Delivery Message:
Where Did You Hear Us:
AGREEMENT
I, the Customer, have read and agree with the terms and conditions set forth in this contract. I accept responsibility for all equipment received, and agree to be responsible for all rental charges, prepaid phone cards, delivery charges if there is any. I authorize Pandasim to process credit card vouchers in my name for all charges I have incurred under the terms of this agreement.
Initials of your first name and last name:
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