AsianNet Gold Membership Application Form

	AsianNet.com - Asia Trade Center

Gold Membership Application Form

1. Basic Information
Already a member	* ( Member ID ) (Please fill in your My Manager ID)
Not yet a member
* Company Name :	(English name)
Company Name :	(Your native Language)
* Contact Person :	Job Title :
* Email :
Telephone :	Ext :
Fax :

2. Payment

Important:
	After you pay by credit card or bank wire transfer, we will send an e-mail within in 2 days to notify you the following procedure.
	If you pay by bank wire transfer, please notify your payment to goldmember@asiannet.com

* Service Term :

US$ 550 US$ 900 US$ 1,150 (one full year)

* Select Payment method :

Important: Please contact Tina Yao to confirm your application and payment
if you don't receive any response in 7 days.

ASIA PACIFIC HEAD OFFICES (Learn more about AsianNet )
AsianNet China Rm. C, 16F, Bldg. 2, 3500, Kai Xuan Road, Shanghai, China Tel: 886-21-64399756 Fax: 886-21-64399756 ext.19 Representative: Blue Kim (ext.14)	AsianNet Taiwan 6F.-7, No.18, Puding Rd., East District, Hsinchu City 300, Taiwan Tel: 886-3-5770775 Fax: 886-3-5775155 Representative: Ester (ext. 224)

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* Card Type : Visa Master American Express ( International Card Only)

* Card Holder Name:

* Card Issuing Bank:

Country/Region:

* Card Number: - - -

* Expiration Date: year month

Beneficiary's name: United Internet Information, Inc. (AsianNet Taiwan)
Account number: 0180010000657-2
Paying Bank: Bank SinoPac, Hsinchu Branch
Swift Code: SINOTWTP018

Important: Please contact Tina Yao to confirm your application and payment if you don't receive any response in 7 days.

Important: Please contact Tina Yao to confirm your application and payment
if you don't receive any response in 7 days.