Please fill the following in CAPITALS

Name: _______________________________________________________________________

Address: _____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________


Pin Code:__________________________________Tel No.: ___________________________

Mobile No.:________________________________e-mail.:_____________________________

YES ! I WOULD LIKE TO PLACE AN ORDER
Product Code.	Description	Qty.	Price per pack	Total
Total (A)

(If above space is insufficient, please add on a seperate sheet of paper)

Add for packing & posting per order : Rs. 50/- for Mumbai or Thane & Rs. 150/- for other areas in India (B)

Add Rs. 50/- for outstanding cheques.

Total Amount enclosed with order

A+B = _________________________________

Cheque / DD No._________________________

Dated__________________________________

Drawn on_______________________________

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