Order Form for Sogetsu Leaflet 2014 草月リーフレット 2014 申込書 ◆ Branch/SG Name: Branch/SG Mr./Mrs./Miss/Ms. Name/氏名: Membership Number／会員番号： Address／住所： Country: Phone： E-mail: ◆ Purpose 使用目的 (Please circle) : Exhibition / Demonstration / Other ( ◆ Order for Complimentary Copies Item Price (¥) # of Copies 200 Complimentary copies (English) Limited to one order per Branch/SG per fiscal year Shipping (Please circle: Surface* / Air / EMS ) TOTAL AMOUNT Free (Up to 200) Please inquire ) Total Price (¥) ¥ 0 ¥ Please fill in the total amount ☞ ¥ <*> The shipment of 200 complimentary copies by surface mail, which sometimes takes up to three months, is free of charge to the Branch/SG. Please ask us about the shipping charge if you would like to have it shipped by Airmail/EMS. ◆ Order for Additional Copies／Individual Orders: Item Leaflet 2014 (English) Shipping (Please circle: Surface / Air / EMS ) TOTAL AMOUNT Price (¥) # of Copies 1000 yen / 100 copies Please inquire Total Price (¥) ¥ ¥ Please fill in the total amount ☞ ¥ <Note> The shipping charges vary depending on the weight, so please ask us about the prices before sending the order form. ◆ Credit Card Details /クレジットカード情報 Credit Card／カードの種類：□ Credit Card Account Number／カード番号：－－－ Expiry Date／有効期限： Month／月 VISA Year／年 Card Holder’s Name (Please print)／カード名義人： Signature／カード名義人署名： Please send this order form to: Overseas Affairs Department, Sogetsu Foundation 7-2-21 Akasaka, Minato-ku, Tokyo 107-8505, JAPAN Phone: +81-3-3408-1151 FAX: +81-3-3405-4947 E-mail: [email protected] Office Only (do not fill this out)／草月会記入欄用紙受付日：＿＿＿＿＿＿＿＿＿＿承認番号：物品発送日：＿＿＿＿＿＿＿＿＿＿入金日：＿＿＿＿＿＿＿＿＿＿承認取得日： □ MASTER