Translation Results Requested Through Conyac Made Public

Legal Business Name

Billing Address

City, Postal Code, Country

Phone
Fax


Buyer Name
E-mail


Accts. Payable Name
E-mail


Freight Forwarder

Address
City
State
Zip

Forwarder Contact Name
Phone
OR:


Check here if you wish to arrange pickup at Surya.

Contact to arrange pickup
Phone


SURyA.COM ACCOUNT ACCESS:
Name
E-mail
EMAIL ADDRESSES FOR DIGITAL NOTIFICATIONS (MAx OF ThREE):
Order Acknowledgements

Invoices (Shipment Notifications)

Return Authorizations

Accounts Payable Statements

Bank Transfer Instructions for Incoming International Wire:

ABA Routing # 254070116 Client Account #9107022825
Name on Account: Surya Carpet Swift Code: CITIUS33
Address: Citibankv
6500 Baltimore National Pike

I am an authorized representative of the above named company, have read this credit card authorization form, and give permission to charge the above card. I acknowledge that
Surya does not accept third-party credit cards and that all Surya Terms and Conditions apply.
(X)
Signature
Date

INTPR 0814