Payment Form

OKA Logo


Please complete the following form to pay for your purchase from OKA AUTO USA division of MIROX Corporation.

* = Required Fields
Company Name:

* Name: (First Last)

* E-mail Address:

Web Site:

* Address:

Address2:

* City:

* State or Province:
US and Canada

Outside US and Canada

* Country:

* ZIP or Postal Code:

* Phone:

* Payment Type:

* Account Number and Expiration (Month/Year):
Input format:
NNNN NNNN NNNN NNNN X MM/YY


Any additional information you wish to provide:

   

Your payment will be processed through our Merchant Account with U.S. Bank
Your Credit Card Statement will show "MIROX Corporation - Las Vegas".

Accepted Payments:

American Express DISCOVER Master Card VISA

American Express DISCOVER Master Card VISA
Credit Cards
are accepted on all direct orders.

Send E-mail to mirox@aol.com with questions or comments about this web site.
Copyright © 2011-2013 MIROX Corporation
Last modified: 2013-05-25

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