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Purchase of Foreign Drafts
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| Date: |
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| Source: |
Web Site |
| SREM Invoice: |
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World's Money Exchange, Inc.
203 N. LaSalle Street, Suite M-11.
Chicago, Illinois 60601
Phone: 312-641-2151
FAX: 312-641-2253
E-mail: anil@wmeinc.com
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| Sold To: |
Name:
Address:
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Day Phone:
E-mail Address:
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| Payee Details: |
Payee Name:
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| Order Details: |
| Currency |
Foreign Amount |
Exchange Rate * |
USD Value |
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| Total: |
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| Draft Fee: |
$15.00 |
| Postal Handling: |
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| Order Total: |
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| Payment Details: |
| This transaction is a: Foreign Draft. |
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| Date & Signature: |
Date: |
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Authorization & Signature: |
_________________________________________________
Please print this form and fax it to (312) 641-2253 [PRINT]
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WMEINC, INC does not assume any responsibility for customer in regards to import/export restrictions.
Please keep yourself informed to these regulations.
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