| Subscriber: |
Institution/Library_________________________________________________________ |
|
_______________________________________________________________________ |
|
Address_________________________________________________________________ |
|
City___________________________ State_______ Zip___________ Country_________ |
| |
| Contact Information: | If possible, please provide the following information in case of questions regarding this subscription |
|
Contact name____________________________________________________________ |
|
Title___________________________________________________________________ |
|
Phone___________________ Fax___________________ Email____________________ |
| |
| Billing Information: | Please note any special billing instructions |
|
Invoice to_______________________________________________________________ |
|
Address________________________________________________________________ |
|
City___________________________ State_______ Zip__________ Country_________ |
| |
| Payment: |
Checks in USD preferred. |
|
[ ] Check made payable to Japanese Art Society of America, Inc. |
|
[ ] A pro-forma invoice is required |
|
[ ] Charge my: [ ] Visa [ ] MasterCard |
|
Card No.______________________________________ Exp. Date (MM/YY) ____ /____ |
|
Signature______________________________________________________________ |