Purchase Order Form Purchase Order Form Purchase Order Form Name * First Last * Last Email * Company Name, Registered in Country Name * Subject * Select to Confirm [Proof must be retained on file] Yes, I have authorization to order Machinery and Medical Equipment. [Certificate Req'd].No, I do not have authorization yet. This is a pre-order.The order requisition includes neither Heavy Machinery nor Medical Equipment. Payment Options for your Requisition [Select] Cash on Delivery Charge Card: M/C; Visa; AMEX Wire Transfer Bank-to-Bank Transfer* PMNT INSTR BELOW Shipping Options for your Requisition [Select] Express Air: Add'l cost applies: 3-days standard Surface Package: No Fee 3-4 weeks standard Instructions: 1. Open the Order_Form Template and fill the Requisition File with your Order Particulars. 2. Save a copy of the completed file on your computer. 3. Upload the completed Requisition file below. 4. Fill the req'd information on this page and click "Submit" button to start processing of the order. 5. AcchingeMall will provide receipt and acceptance of the Order_Requisition to the email address noted on this form. 6. Payment Instructions: ACCOUNT NAME: ACCHINGE 12878445 CAN. C/O SAAYA SAHITHI, ACCHINGEMALL SWIFT/BIC:TRWICAW1XXX ACCOUNT: 200110520088 INSTITUTION: WISE PAYMENTS CANADA INC. 99 BANK STREET, SUITE 1420 OTTAWA ON K1P 1H4 CANADA Currency Converter Remittance Currency * Select CurrencyAFNAMDBDTCADEURINRJPYLKRPKRTHB Remittance Amount in Currency * Order Total in INR * Payment Transaction Reference Number * Any questions or special instructions? * Submit If you are human, leave this field blank.