Please (1) Print this form. (2) Use a pen to fill the form. (3) Fax the form. Thank you.
CIAX.COM
CIAX.COM, 5 LONGHEY RD, MANCHESTER, M22 8UA, UNITED KINGDOM
Tel: +44 161 902 0980 Fax: +44 161 945 8169 Email: helpCIAX.com

FAX: 0161 945 8169

 
ORDER NUMBER: DATE:

ADDRESS: To appear on Sales Invoice

CONTACT: COMPANY:
ADDRESS:
CITY: POST CODE / ZIP:
TEL: FAX:
EMAIL: <<< IMPORTANT: Email address for delivery of software
ORDER CODE PRICE QUANTITY SUB-TOTAL
    
=
    
=
    
=

TOTAL:

=
Swift / CHAPS / Bank Wire Transfer / Telegraphic Transfer

GB - I will pay using my bank, by wire transfer. If you need an invoice, before payment, please request an invoice. When your payment arrives, we will send your products.

Bank NATIONAL WESTMINSTER BANK, 2 CHURCH ROAD, NORTHENDEN, MANCHESTER, M22 4NE, UNITED KINGDOM
Account Name JIT (UK) LTD
Account Number 22015361
Sort Code 60-15-25
SWIFT (BIC) NWBK GB 2L
IBAN GB80 NWBK 6015 2522 0153 61