甲方(盖章):____________________乙方(盖章):____________________
授权代理人:(签字)______________授权代理人:(签字)______________
住址:____________________________住址:____________________________
邮政编码:________________________邮政编码:________________________
联系电话:________________________联系电话:________________________
传真:____________________________传真:____________________________
日期:____________________________日期:____________________________
电子信箱:________________________电子信箱:________________________
开户银行:________________________开户银行:________________________
账号:____________________________账号:____________________________