| Subscriber: |
Institution/Library_____________________________________________ |
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__________________________________________________________ |
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Address_____________________________________________________ |
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City_____________________ State_____ Zip________ Country_________ |
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| Contact Information: |
If possible, please provide the following information in case of questions regarding this subscription |
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Contact name__________________________________________________ |
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Title________________________________________________________ |
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Phone_________________ Fax______________ Email_________________ |
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| Billing Information: |
Please note any special billing instructions |
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Invoice to___________________________________________________ |
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Address_______________________________________________________ |
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City_____________________ State_____ Zip________ Country_________ |
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| Payment: |
Checks in USD preferred. |
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[ ] Check made payable to Japanese Art Society of America, Inc. |
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[ ] A pro-forma invoice is required |
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[ ] Charge my: [ ] Visa [ ] MasterCard [ ] American Express |
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Card No._____________________________ Exp. (MM/YY) ____ /____ |
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Signature_____________________________________________________ |