甲方:__________________(盖章)乙方:_______________________(盖章)
法定**人签字:________________法定**人签字:_____________________
(委托**人):________________(委托**人):_____________________
地址:__________________________地址:_______________________________
邮编:__________________________邮编:_______________________________
电话:__________________________电话:_______________________________
传真:__________________________传真:_______________________________
开户银行:______________________开户银行:___________________________
开户银行账号:__________________开户银行账号:_______________________
***登记号:__________________***登记号:_______________________
签订日期:_______年____月_____日签订地点:___________________________