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| FREE
TICKET AND PLAYER REGISTRATION FORM |
| Please check the
appropriate boxes. Choose your payment currency from the pop-up lists. |
| I want my FREE ticket. I enclose 4 stamps or International
Reply Coupons. |
| I want to buy (Qty) PRs at |
Enter sub-total
|
|
PAYMENT METHOD:
Postal Order IMO Credit Card Cash
[NOTE: BIG does NOT accept personal
checks.] |
Write payment
method
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POSTAL ORDER / IMO SURCHARGE
If you pay by
postal order or international money order, you must also pay a flat processing surcharge, e.g. for
US$ you add $15, for UK£ you add £10, etc |
Select surcharge
amount
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|
CREDIT CARD (CC) SURCHARGE OF 5%
Credit card orders are charged in US$ dollars only and incur a
5% surcharge to cover processing fees. Your card will be debited at some point one month
after receipt of your order and before the expiration date of your card. Please enter your
card details below:
MasterCard Visa Amex Other
Card No / /
/
Exp. / Name on Card |
Write 5% CC charge
|
TOTAL
PAYMENT ENCLOSED
|
|
5% REFUND FOR
CASH ORDERS ONLY
If you are paying by cash, then plese calculate 5% of the value
of your total order and write the amount in the box opposite. This amount will be credited
to your ABS account. Cash should be sent by either registered post or courier. BIG values
cash payments. |
Write 5% cash
refund
|
|
EXISTING
PLAYERS
If you are re-ordering more PR's, then please enter your PAN: |
Player Account No
PAN
|
|
AGENT ID
If you were introduced to BIG by one of our agents, please enter the agent's ID# or delete Terra Libra's ID# and write in name, phone
#, and country of your agent |
Agent ID
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|
Please post this form with payment or 4 IRCs (if Free Ticket) to:
SEND REGULAR MAIL TO:
Agora Office Services
(Jakarta)
PO Box 6061
JKPMT 10310
INDONESIA
SEND MAIL BY COURIER TO:
Agora Office Services
Jalan Subang No. 6
Menteng
Jakarta Pusat, 10310
INDONESIA
Make all payments to "Courtney Agencies"
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