电话：_____________________电话：______________________
电传：_____________________电传：______________________
邮政编码：_________________邮政编码：__________________
开户银行：_________________开户银行：__________________
帐号：_____________________帐号：______________________
_________年______月______日________年_______月_______日
签订地点：_________________签订地点：__________________