Your Full Name:Kiyeto.Takata ________________________________________________________________________________________________________________
Your Ship's Call Sign:Kiyeto.Takata ________________________________________________________________________________________________________________
Proof of your ID and IFF:click ________________________________________________________________________________________________________________
Proof of Neutral or Friendly Reputation with Samura Heavy Industries:click ________________________________________________________________________________________________________________
Your Reason(s) for Applying:Trading purposes ________________________________________________________________________________________________________________
Proof of the Transaction:Please send 100,000 credits to: Samura|-Shinjuku; {No fee for Samura individuals} and Insert the Proof of Transaction Here