Name
Family Name
Date of Birth
Age
Occupation
New Membership
Renew Membership
MS No : SLM -07
Deliver to Home Company
Address
Zip / Postcard / P.O.Box
Office Tel
Home Telephone
Mobile
Fax
e-mail

1 YEAR SUBSCRIPTION : 12 ISSUES

280,000 kip
350,000 kip
US$ 85.00
US$ 98.00
US$ 120.00
Start from Issue No.
( Month :
/2007 )
To Issue No.
( Month :
 /2008 )
Total order per Month
Total Amount ( yearly ) ( Kip/ US$ )


CLEARANCE

 Cash in Kip/us$
Check payable to ARIYA Advertising Services Co., Ltd.
Transfer to account number 01.4548000.05655 ( us$ ), Public Bank, Vientiane Branch

TERM & CONDITIONS
Payment must be made within 1 week after the contract signed.
Verification code:


 
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