合同编号：______________
出质人：_____________________________________
法定住址：___________________________________
法定代表人：_________________________________
职务：_______________________________________
委托代理人：_________________________________
身份证号码：_________________________________
通讯地址：___________________________________
邮政编码：___________________________________
联系人：_____________________________________
电话：_______________________________________
传真：_______________________________________
帐号：_______________________________________
电子信箱：___________________________________
开户金融机构：_______________________________
账号：_______________________________________
质权人：_____________________________________
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