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Please fill out the form below completely and accurately to ensure fast processing of your order.

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Fax Number: 022-66459707

Shipping Address

Title: Company:
First Name: Surname:
Address 1:
Address 2:
Town/Suburb: County:
Postal Code: Country:
Telephone: E-mail:
Product Name Qty. Price Subtotal
$ $
$ $
$ $
$ $
$ $
$ $
$ $
Shipping and Handling is ₹ 195 for all orders with a subtotal under ₹ 1,999.
Shipping and Handling is free over ₹ 1,999 !
SUBTOTAL: $
SHIPPING & HANDLING: $
ORDER TOTAL ($): $

Payment Method

 
Credit Card (Please complete the information below)
  Visa   MasterCard
 
Name on Card:
Card Number:
Expiry: -
Security Code: Visa/Mastercard is a 3-digit number
on the back of the card
Signature: _______________________________
Date: - -
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