┌────┬─────────────────────────────┐    │证券种类│                                                          │    ├────┼─────────────────────────────┤    │数    量│                                                          │    ├────┼─────────────────────────────┤    │指定价格│                                                          │    ├────┼─────────────────────────────┤    │预存金额│                                                          │    ├────┼─────────────────────────────┤    │现 定 期│                                                          │    ├────┼─────────────────────────────┤    │限    期│                                                          │    ├────┼─────────────────────────────┤    │备    考│                                                          │    └────┴─────────────────────────────┘　　上列证券委托 贵公司买入请即依照 贵公司代买证券规则办理此致上海信托股份有限公司　　台照　　                                                 （签名盖章）　　委托者：　　信 址　　                                                   年 月 日