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傳真訂購單Fax Order Form
會員號碼
Membership Number
Membership Number
日期
Date
會員姓名
Name
Name
統一編號
TAX No
聯絡電話
TEL
TEL
傳真號碼
FAX
收貨人
Consignee
Consignee
送貨地址
Delivery Address
Delivery Address
配送日期
Delivery Date
Delivery Date
取貨方式
Pick-up Method
Pick-up Method
商品編號
Item No.
Item No.
商品名稱
Description
Description
數量
Qty.
Qty.
單價
Unit Price
Unit Price
總 計 / TOTAL 至少一萬元 / $10,000 Minimum
※依據「食品安全衛生管理法」第九條、「應建立食品追溯追蹤系統之食品業者」及「菸酒管理法」第30條第1項規定，請據實告知本訂單購買用途為： (必勾選)
According to Article 9 of the "Act Governing Food Safety and Sanitation," "Food Businesses Shall Establish Traceability System of Food Products", and Article 30 of the "Tobacco and Alcohol Administration Act," please tell us about your purpose of this order: (*Required*)
According to Article 9 of the "Act Governing Food Safety and Sanitation," "Food Businesses Shall Establish Traceability System of Food Products", and Article 30 of the "Tobacco and Alcohol Administration Act," please tell us about your purpose of this order: (*Required*)
付款方式
Method of Payment
Method of Payment
(1) 以信用卡方式付款 Pay By Credit Card
信用卡卡號
Credit Card No.
Credit Card No.
有效期限
Ex. Date
Ex. Date
消費金額
Amount N.T. Dollar
Amount N.T. Dollar
持卡人姓名
Card Holder's Name
Card Holder's Name
持卡人簽名
Authorized Signature
Authorized Signature
*請勿使用email傳送信用卡資料，請以傳真方式提供。
Do not submit credit card detail via email, please provide by fax
*信用卡持卡人須與Costco會員卡持卡人為同一人The credit card holder must be the same person as the Costco membership cardholder
*持卡人同意依照信用卡使用規定，一經使用或訂購物品，均應按照所指示之全部金額付款於發卡銀行。
The issuer of the card identified on this form is authorized to pay the amount shown as total upon proper presentation.
I promise to pay such total (together with any other charges due thereon) subject to and in accordance with the agreement governing the use of such card.
Costco 承辦人簽章
Costco Representative Signature
Costco Representative Signature