H A P P Y B I R T H D A Y G R A N D M A S T E R C H O A K O K S U I !
With Deep Love and Gratitude!
Please receive my gift of US$ __________ / EURO€ __________
Name ___________________________________________
Phone No. ________________________ Fax No. ____________________________
Email _______________________________
Address _____________________________________________________________
State __________________ Zip __________________
Country ______________________________
Birthday (Bank Requirement) ____/____/____ (MM/DD/YY)
Please charge my credit card (please check):
( ) Visa ( ) Mastercard
Card No. ________________________ Expiration Date: _______________________
Amount _________________________ Issuing Bank _________________________
Signature _________________________________
Last 3 digits at the back of your card ___________
Card billing address (if different from above) :
_____________________________________________________________________