Print and fax to: Asiatica Association - Sales Department via V. Bellini 4, 20122 Milano, Italy Fax: +39 2 76011736 - Email: [email protected] Date: / /199 ----------------------- Name and Shipping Address ----------------------- First Name: ________________________ Middle Name: ______________________ Last Name: ______________________________ Title: ______________________ Institution: ____________________________________________________________ Address: ____________________________________________________________ ____________________________________________________________ City: ______________________________ State: ______ Zip: __________ Country: ______________________________ Email: ______________________ Telephone: ______________________________ Fax: ______________________ ----------------------- Order Details ----------------------- (Select) (Description) (Quantity) (Unit Price) (Total) [ ] JSAWS 1995-1997 printed book ______ US$ 27.00 US$ ______ [ ] JSAWS subscription (book+WWW) ______ US$ 60.00 US$ ______ [ ] Extraordinary Membership (both Journals WWW + JSAWS book) ______ US$ 100.00 US$ ______ Shipping (1st book) US$ 7.00 US$ 7.00 Shipping (additional books) ______ US$ 5.00 US$ ______ Total US$ ______ ----------------------- Payment Details ----------------------- credit card orders will be debted in Italian Lira at the current exchange rate (approx. 0.000557994 USD/ITL 1794.38 ITL/USD) Date of Birth dd/mm/yy (required for c/c orders) _______/_______/_______ [ ] Visa No. __________________________________________ Exp. __/______ Name _________________________________________________________ [ ] Mastercard No. ____________________________________ Exp. __/______ Name _________________________________________________________ [ ] International Money Order (please enclose copy of payment slip) Customer Name: Asiatica Association Bank Name: Banco Ambrosiano Veneto Branch: 099 - Milano alla Scala Address: Piazza Paolo Ferrari 10, Milano, MI 20100 Italy Account#: 1666/92 SWIFT#: BAVEITMM099 _____________________________ (Sign here)