填空题
Name: (1) Date: (2)
No. 100017 - 03011
Address: 91 Changdi Rd, Guangzhou,
　　　　　　Guangdong Province 510120
　　　　　　China
Particulars : (3)
Total Amount: (4)
(5)
( ) We have credited your account
( ) Please debit our account
( ) We enclose herewith our Cashier's Order/Demand Draft
( ) We have credited settle, bank a/c in your favor
Authorized Signature: (6)