Purchase Order Form

Name

First

Last

Email

Company Name, Registered in Country Name

Subject

Select to Confirm [Proof must be retained on file]

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:

Remittance Currency

Remittance Amount in Currency

Order Total in INR

Payment Transaction Reference Number

Any questions or special instructions?